Effectiveness of Integrating Simulation with Art-Based Teaching Strategies on Oncology Fellows' Performance Regarding Breaking Bad News.

The task of breaking bad news (BBN) may be improved by incorporating simulation with art-based teaching methods. The aim of the present study was to assess the effect of an integrating simulation with art-based teaching strategies, on fellows' performance regarding BBN, in Iran. The study was carried out using quasi-experimental methods, interrupted time series. The participants were selected from medical oncology fellows at two teaching hospitals of Tehran University of Medical Sciences (TUMS), Iran. Participants were trained through workshop, followed by engaging participants with different types of art-based teaching methods. In order to assess the effectiveness of the integrating model, fellows' performance was rated by two independent raters (standardized patients (SPs) and faculty members) using the BBN assessment checklist. This assessment tool measured seven different domains of BBN skill. Segmented regression was used to analyze the results of study. Performance of all oncology fellows (n = 19) was assessed for 228 time points during the study, by rating three time points before and three time points after the intervention by two raters. Based on SP ratings, fellows' performance scores in post-training showed significant level changes in three domains of BBN checklist (B = 1.126, F = 3.221, G = 2.241; p < 0.05). Similarly, the significant level change in fellows' score rated by faculty members in post-training was B = 1.091, F = 3.273, G = 1.724; p < 0.05. There was no significant change in trend of fellows' performance after the intervention. Our results showed that using an integrating simulation with art-based teaching strategies may help oncology fellows to improve their communication skills in different facets of BBN performance. Iranian Registry of Clinical Trials ID: IRCT2016011626039N1.

Narrative discourse impairments in Persian-speaking persons with traumatic brain injury: a pilot study.

OBJECTIVE: Studies have shown the presence of narrative discourse difficulties in persons with traumatic brain injury (TBI), even in those who do not suffer from aphasia. Yet, there still exist inconsistencies between the results of different studies, in particular at the microlinguistic level. Moreover, a limited number of languages have been studied in this regard. Therefore, this study aimed at examining these skills in Persian-speaking individuals with TBI. The purpose of this pilot study was to analyse the microlinguistic and macrolinguistic skills of these individuals to determine impaired linguistic measures at different levels of narrative discourse. PARTICIPANTS AND METHODS: Fourteen non-aphasic Persian-speaking persons with TBI (9 with severe TBI and 5 with moderate TBI), aged 19-40 years (mean = 25.84, SD = 5.69), and 61 age-matched healthy adults completed a narrative task. Measures of language productivity, clause density, verbal error ratio, and cohesion ratio were calculated. Also, test-retest and inter-rater reliability coefficients were analysed. RESULTS: The TBI group was impaired in some microlinguistic and all macrolinguistic measures compared to their control peers. CONCLUSION: The results of this study suggest that multi-level narrative discourse analyses of Persian-speaking individuals with TBI may be useful for speech/language pathologists wishing to evaluate communication disorders in persons with TBI.

Persian adaptation of Edinburgh Cognitive and Behavioural Screen (ECAS).

Objectives: To adapt the Edinburgh Cognitive and Behavioral screen (ECAS) English version into Persian. Methods: The ECAS test was adapted and implemented to 30 ALS patients and 31 healthy volunteers in Tehran, Iran. The ECAS results were compared to MoCA and ALS-FRS-r, the other standard tools to determine whether the translated version is reliable and valid in the new language. In addition, the patients' caregivers were interviewed for behavioral and psychiatric changes. Results: The Persian version of ECAS revealed high internal consistency (α = 0.791), alongside the strong correlation of ECAS and its subscales with MoCA and ALS-FRS. Moreover, Persian ECAS discriminated against the patients and the healthy population well. Sensitivity analysis revealed promising results of Persian ECAS with an area under the curve of 0.871 in ROC curve analysis. Cognitive impairment was observed in 43.33% of patients. Conclusion: The Persian version of the ECAS, exclusively designed for the Iranian population, is the first screening tool to assess multiple neuropsychological functions, which provides a rapid and inclusive screen of cognitive and behavioral impairments specifically in ALS patients.

The Singing Voice Handicap Index (SVHI): Validation and Adaptation Into Persian.

OBJECTIVES: The aim of the present study is to develop, validate, and assess the reliability of the Persian version of Singing Voice Handicap Index (SVHIp) as a self-reported questionnaire for singers with voice disorders that measure the patient's self-perceived voice handicap. STUDY DESIGN: This is a cross-sectional study. MATERIALS AND METHOD: During this study, the Persian version of singing voice handicap index was administered to 115 singers (90 male and 25 female, age range: 22-45 years). Voice disorder was confirmed by video-stroboscopic evidences in 48 participants, while 67 were healthy without any voice disorders. To assess the content validity, the prefinal questions were given to 15 experts to comment on its content applicability and relevance through a Likert scale. Seventy five singers rated its importance to detect face validity. To evaluate the concurrent validity, the same 75 participants completed both the SVHIp as well as a visual analog scale. The SVHI total scores of the singers with diagnosed voice disorder and of the healthy singers were compared to test the clinical validity (discriminant validity). Also, internal consistency reliability was assessed using Cronbach α coefficient. The relative reliability was calculated by asking 40 of all singers to complete the SVHIp twice, with a week of interval between the first and the second times. To detect the absolute reliability, Standard Error of Measurement and Smallest Detected Change were calculated. Responsiveness was measured for the Persian version of SVHI by comparing the individual patient scores before and after the treatment. RESULTS: The SVHI was favorably accepted with no deletions. Discriminative validity differed significantly between singers with and without voice disorder. There was a significant correlation between the SVHIp and visual analog scale total scores (P < 0.05). The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.95). The Standard Error of Measurement and Smallest Detected values were acceptable (0.39 and 1.08), respectively. The Cohens' d effect size indicates the high responsiveness for SVHIp. CONCLUSIONS: The Persian SVHI was demonstrated to be a valid and reliable self-rated questionnaire for use in Persian-singers.

Voice Changes During Pregnancy Trimesters in Iranian Pregnant Women.

OBJECTIVE: This study aimed to evaluate the vocal changes in the Iranian pregnant women according to trimesters both objectively and subjectively. METHODS: There were 93 pregnant women and 31 non-pregnant women participants in the study. Thirty-three of the 93 pregnant women were in their first trimester, 31 in their second trimester, and 29 in their third trimester of their pregnancies. Clinical data were collected from the acoustic measurements, aerodynamic assessment, video laryngoscopy examination, and the self-assessment of quality of life related to voice using the Persian Voice Handicap Index (VHIP). The analysis of variance (ANOVA) test and Kruskal-Wallis test were used for between-group comparisons of the data. RESULTS: Decreased maximum phonation time (MPT), increased S/Z ratio, increased VHIP-30 scores, and evidence of vocal fold edema were the parameters that differed significantly only in the third trimester. Acoustic analysis revealed that F0, jitter, shimmer, and noise-to-harmonics ratio (NHR) were not significant across the four groups. CONCLUSIONS: Results showed that decreased MPT, increased S/Z ratio, mild to moderate edema, and a deterioration of the VHIP-30 score noticeably occurred during the third trimester. The results suggest significant vocal changes toward less stable phonation during the third trimester of pregnancy.

Discourse in aging: Narrative and Persuasive.

The growth in the elderly population has posed a social, economic and health challenge for the twenty-first century. OBJECTIVE: Aging is often characterized by changes in cognitive functions which affect the receptive and expressive capabilities of language. Since language plays a significant role in human life, we evaluate the existence of age-related differences in narrative and persuasive discourses. METHODS: The narrative discourse of 91 adults and persuasive discourse of 92 adults,aged from 19 to 75 years and stratified into four age groups,were examined. RESULTS: There was a statistically significant difference between coherence in the elderly group and each of the other three age groups for both types of discourse. There was also a significant difference for the cohesion variable between the elderly and the first age group for narrative discourse only. CONCLUSION: The results of this study demonstrate that discourse is influenced by aging and type (genre) of discourse task. Therefore, it is essential for clinicians to take into account the linguistic needs of elderly and incorporate these into their clinical programs. Also, this finding can help clinicians to distinguish between discourses of normal aging and other neurologic disorders (for example dementia, right hemisphere damage, aphasia).

O aumento da população idosa colocou um desafio social, econômico e de saúde para o século XXI. OBJETIVO: O envelhecimento é frequentemente caracterizado pela presença de alterações nas funções cognitivas que afetam as capacidades receptivas e expressivas da linguagem. Como a linguagem desempenha um papel significativo na vida humana, avaliamos a existência de diferenças relacionadas à idade nos discursos narrativos e persuasivos. MÉTODOS: O discurso narrativo de 91 adultos e o discurso persuasivo de 92 adultos com idade entre 19 e 75 anos, divididos em quatro faixas etárias, foram examinados. RESULTADOS: Existe uma diferença estatisticamente significativa entre a coerência no grupo de envelhecimento e cada um dos outros três grupos nos dois tipos de discursos. Existe também uma diferença significativa para a variável coesão entre idosos e a primeira faixa etária apenas no discurso narrativo. CONCLUSÃO: Os resultados deste estudo demonstram que o discurso é influenciado pelo envelhecimento e tipo da tarefa discursiva. Portanto, é essencial que os médicos levem em consideração as necessidades linguísticas dos idosos e as incorporem em seus programas clínicos. Além disso, esses resultados ajudam os médicos a distinguir entre discursos de envelhecimento normal e outros distúrbios neurológicos (por exemplo, demência, lesões do hemisfério direito, afasia).

Psychometric properties of the communication skills attitude scale (CSAS) measure in a sample of Iranian medical students.

INTRODUCTION: Communication skill (CS) has been regarded as one of the fundamental competencies for medical and other health care professionals. Student's attitude toward learning CS is a key factor in designing educational interventions. The original CSAS, as positive and negative subscales, was developed in the UK; however, there is no scale to measure these attitudes in Iran. The aim of this study was to assess the psychometric characteristic of the Communication Skills Attitude Scale (CSAS), in an Iranian context and to understand if it is a valid tool to assess attitude toward learning communication skills among health care professionals. METHODS: Psychometric characteristics of the CSAS were assessed by using a cross-sectional design. In the current study, 410 medical students were selected using stratified sampling framework. The face validity of the scale was estimated through students and experts' opinion. Content validity of CSAS was assessed qualitatively and quantitatively. Reliability was examined through two methods including Chronbach's alpha coefficient and Intraclass Correlation of Coefficient (ICC). Construct validity of CSAS was assessed using confirmatory factor analysis (CFA) and explanatory factor analysis (PCA) followed by varimax rotation. Convergent and discriminant validity of the scale was measured through Spearman correlation. Statistical analysis was performed using SPSS 19 and EQS, 6.1. RESULTS: The internal consistency and reproducibility of the total CSAS score were 0.84 (Cronbach's alpha) and 0.81, which demonstrates an acceptable reliability of the questionnaire. The item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI/Ave) demonstrated appropriate results: 0.97 and 0.94, respectively. An exploratory factor analysis (EFA) on the 25 items of the CSAS revealed 4-factor structure that all together explained %55 of the variance. Results of the confirmatory factor analysis indicated an acceptable goodness-of-fit between the model and the observed data. [χ2/df = 2.36, Comparative Fit Index (CFI) = 0.95, the GFI=0.96, Root Mean Square Error of Approximation (RMSEA) = 0.05]. CONCLUSION: The Persian version of CSAS is a multidimensional, valid and reliable tool for assessing attitudes towards communication skill among medical students.

Persuasive discourse impairments in traumatic brain injury.

BACKGROUND: Considering the cognitive and linguistic complexity of discourse production, it is expected that individuals with traumatic brain injury (TBI) should face difficulties in this task. Therefore, clinical examination of discourse has become a useful tool for studying and assessment of communication skills of people suffering from TBI. Among different genres of discourse, persuasive discourse is considered as a more cognitively demanding task. However, little is known about persuasive discourse in individuals suffering from TBI. OBJECTIVES: The purpose of this study was to evaluate the performance of adults with TBI on a task of spoken persuasive discourse to determine the impaired linguistic measures. PATIENTS AND METHODS: Thirteen TBI nonaphasic Persian speaking individuals, ranged between 19 to 40 years (Mean = 25.64 years; SD = 6.10) and 59 healthy adults matched by age, were asked to perform the persuasive discourse task. The task included asking the participants to express their opinion on a topic, and after the analysis of the produced discourse, the two groups were compared on the basis of their language productivity, sentential complexity, maze ratio and cohesion ratio. RESULTS: The TBI group produced discourses with less productivity, sentential complexity, cohesion ratio and more maze ratio compared the control group. CONCLUSIONS: As it is important to consider acquired communication disorders particularly discourse impairment of brain injured patients along with their other clinical impairments and regarding the fact that persuasive discourse is crucial in academic and social situations, the persuasive discourse task presented in this study could be a useful tool for speech therapists, intending to evaluate communication disorders in patients with TBI.

Discourse in aging: Narrative and Persuasive / Discurso no envelhecimento: narrativa e persuasiva

ABSTRACT The growth in the elderly population has posed a social, economic and health challenge for the twenty-first century. Objective: Aging is often characterized by changes in cognitive functions which affect the receptive and expressive capabilities of language. Since language plays a significant role in human life, we evaluate the existence of age-related differences in narrative and persuasive discourses. Methods: The narrative discourse of 91 adults and persuasive discourse of 92 adults,aged from 19 to 75 years and stratified into four age groups,were examined. Results: There was a statistically significant difference between coherence in the elderly group and each of the other three age groups for both types of discourse. There was also a significant difference for the cohesion variable between the elderly and the first age group for narrative discourse only. Conclusion: The results of this study demonstrate that discourse is influenced by aging and type (genre) of discourse task. Therefore, it is essential for clinicians to take into account the linguistic needs of elderly and incorporate these into their clinical programs. Also, this finding can help clinicians to distinguish between discourses of normal aging and other neurologic disorders (for example dementia, right hemisphere damage, aphasia).

RESUMO O aumento da população idosa colocou um desafio social, econômico e de saúde para o século XXI. Objetivo: O envelhecimento é frequentemente caracterizado pela presença de alterações nas funções cognitivas que afetam as capacidades receptivas e expressivas da linguagem. Como a linguagem desempenha um papel significativo na vida humana, avaliamos a existência de diferenças relacionadas à idade nos discursos narrativos e persuasivos. Métodos: O discurso narrativo de 91 adultos e o discurso persuasivo de 92 adultos com idade entre 19 e 75 anos, divididos em quatro faixas etárias, foram examinados. Resultados: Existe uma diferença estatisticamente significativa entre a coerência no grupo de envelhecimento e cada um dos outros três grupos nos dois tipos de discursos. Existe também uma diferença significativa para a variável coesão entre idosos e a primeira faixa etária apenas no discurso narrativo. Conclusão: Os resultados deste estudo demonstram que o discurso é influenciado pelo envelhecimento e tipo da tarefa discursiva. Portanto, é essencial que os médicos levem em consideração as necessidades linguísticas dos idosos e as incorporem em seus programas clínicos. Além disso, esses resultados ajudam os médicos a distinguir entre discursos de envelhecimento normal e outros distúrbios neurológicos (por exemplo, demência, lesões do hemisfério direito, afasia).

The assessment of pragmatics in Iranian patients with right brain damage.

BACKGROUND: Pragmatics is appropriate use of language across a variety of social contexts that provides accurate interpretation of intentions. The occurrence of the right hemisphere lesions can interfere with pragmatic abilities, and particularly with the processing of nonliteral speech acts. METHODS: Since the objective of this study was to assess different aspects of pragmatic competence in the right hemisphere damage (RHD) patients, 20 Iranian patients with right hemisphere lesions were examined by adult pragmatic profile (APP) and a novel checklist was introduced for Persian language speaking individuals. Meanwhile, 40 healthy adult individuals, who were age and gender matched with RHD patients, were considered as the control group. After obtaining video records, all subjects were evaluated for 35 pragmatic skills, including 24 verbal, 5 paralinguistic, and 6 nonverbal aspects, by a two-point scale system. RESULTS: Studying RHD patients and their healthy counterparts revealed that the performance by participants with right hemisphere lesions exhibited a high degree of inappropriate pragmatic abilities compared with controls in all domains. Furthermore, RHD patients showed a trend of increasing difficulty in understanding and producing different pragmatic phenomena, including standard communication acts. CONCLUSION: Present results indicated that the right hemisphere lesions significantly affected pragmatic abilities in verbal, paralinguistic and nonverbal aspects. Such a pattern of performance, which is in line with deficits previously reported for RHD, proved the unquestioned role of the right hemisphere in processing nonliteral language.

Voice-related disability of Iranian patients with temporomandibular disorders.

INTRODUCTION: The relationship between handicaps because of voice disorders and temporomandibular disorders (TMDs) severity was examined. METHOD: Fifty-two Persian women with temporomandibular disorder (TMD) were examined by two dentists in separate sessions and the assessment protocol of the Dentistry Clinic of Tehran University of Medical Sciences was filled by both dentists and finally they gave their opinion separately about the existence of TMD and categorized the severity of TMD as mild, moderate, and severe. To assess perceived disability resulting from voice disorders in TMD patients, the voice handicap index (VHI) questionnaire was used. RESULTS: The total score of VHI in 80.8% of patients with TMD was equal to or more than 14.5. A significant positive relationship was found between the severity of TMD and the total score of VHI (P = 0.000, r = 0.79). CONCLUSIONS: It seems that a comprehensive voice assessment should be included in the evaluation of TMD, and considering different effects of voice disorders on patients' lives, a complete voice evaluation including voice-related disability is necessary to understand the nature of pathophysiology of TMD.

Cross-cultural adaptation and validation of the voice-related quality of life into Persian.

The purpose of this study was to adapt and determine reliability, validity, and responsiveness of voice-related quality of life (V-RQOL) for Persian. A total of 300 patients with voice disorders participated in the study. Also, 116 people without any voice disorders volunteered to participate in the study as a control group. All participants filled in the Persian version of V-RQOL. The reliability, validity, and responsiveness were studied. Results demonstrated that the discrimination coefficient is significant for all items. The V-RQOL measure showed a strong internal consistency (Cronbach alpha coefficient = 0.88-0.91) and a good test-retest reliability (r = 0.93-0.95). Pre- and post-treatment results showed a significant responsiveness (functioning, 0.000; social-emotional, 0.001; and total, 0.000). Effect size range of 1.26-1.59 and the standardized response mean range of 1.07-1.41 were obtained for V-RQOL. It seems that the Persian version of V-RQOL is valid, reliable, and responsive to change, and this questionnaire can be used for completing voice evaluation for patients with dysphonia.