ABSTRACT
BACKGROUND: Many people receiving medical treatment in Switzerland speak none of the country's four languages or English, which is a major communicative barrier for health staff. Appropriate treatment in hospitals depends on the successful communication between hospital staff and patients. Consequently, migrant patients can be particularly challenging for hospital staff. AIMS: The aim of this project was to examine the following topics: (a) which communicative challenges hospital nurses are confronted with in the care of migrant paediatric patients and how they cope with them, and (b) what requirements nurses (and other stakeholders) have regarding a digital communication aid to improve the care of migrant paediatric patients in the hospital setting. METHODS: This study used a qualitative approach. The following steps of data collection were undertaken: (a) two literature searches corresponding to the research questions, (b) a focus group interview with paediatric hospital nurses, (c) observation of communication between paediatric nurses/healthcare professionals and children/parents through shadowing, (d) short interviews with paediatric nurses who were being shadowed, and (e) a focus group interview with experts. Data analysis was based on thematic analysis and was supported by MAXQDA software. RESULTS: Evaluation of the data showed there are multiple communicative challenges that emerge in the care of migrant paediatric patients. These challenges influence each other and appear at different moments in the hospital stay. Additionally, the results revealed that digital communication aids must be user friendly and easily accessible. CONCLUSIONS: This study highlights the areas of hospital care in which a digital communication aid could be feasible. However, many of the described communication challenges stem from issues that cannot be solved solely with a digital communication aid. Instead, strategies to tackle these issues must be embedded in the training of nursing staff, in the hospital management strategy and at the political level.
ABSTRACT
There is decreased activity of glutamate carboxypeptidase II (GCP II) in the dorsolateral prefrontal cortex (DLPFC) and hippocampus of patients with schizophrenia. GCP II hydrolzses N-acetyl-alpha L-aspartyl-L-glutamate (NAAG), a peptide in the mammalian brain that binds to the N-methyl D-aspartate (NMDA) receptor and a group II metabotropic glutamate receptor, both of which have been implicated in the pathophysiology of schizophrenia. We examined the expression of GCP II mRNA in the DLPFC, entorhinal cortex (ERC), and hippocampus in postmortem samples from patients with schizophrenia and normal controls using in situ hybridization followed by silver grain detection. GCP II mRNA was detected in glial cells. Glial-rich regions, specifically the DLPFC and ERC white matter and the molecular and polymorphic layers in the hippocampus, express high levels of GCP II mRNA. Given the earlier finding of decreased GCP II activity in brains of subjects with schizophrenia, we expected to find lower GCP II mRNA levels in schizophrenia. Contrary to this expectation, we found a significantly higher expression of GCP II mRNA in one of the brain areas examined, the hippocampal CA3 polymorphic region. This may reflect a compensatory increase to correct for the decreased activity of GCP II activity. Our findings support the notion that the hydrolysis of NAAG is disrupted in schizophrenia and that specific anatomical regions may show discrete abnormalities in GCP II synthesis.
