Background: There has been a rise in dementia awareness, with policy changes leading to increased diagnosis rates. However, the stigma of dementia is likely to cause challenges in diagnostic communication. This is complicated by the effect of dementia on cognitive functioning. The aims of this study were to (1) identify how diagnoses of dementia are communicated, (2) identify how people with dementia respond to the diagnosis, and (3) explore doctors’ perspectives on dementia diagnosis delivery. Methodology: A systematic literature review was conducted. Twenty doctors from 9 memory clinics across 4 NHS trusts participated. Eighty-one dementia diagnosis feedback meetings were video-recorded. Conversation analysis was used to identify patterns in diagnosis delivery. Four focus groups with the participating doctors were analysed using thematic analysis (inter-rater reliability 0.89). Findings: The literature review highlighted the dilemma of communicating both sensitively and honestly with people with dementia, as well as challenges stemming from cognitive impairment. This was also evident in diagnostic communication. Prior to diagnosis doctors elicited patient orientation to the meeting purpose (“do you know why you’re here?) and perspective into symptoms (“how is your memory?”). The majority of patients displayed some confusion as to the meeting purpose and offered non-medicalised explanations for their symptoms. Doctors attempted to address this through repeated explication of test results and statements of the clinic purpose. Dementia was always explicitly named. Diagnoses were often delivered indirectly (“that is dementia”), a practice to manage patient resistance and negative responses. However, over 40% were delivered directly (“you have dementia”), especially when patients were more cognitively impaired. Doctors pursued non-minimal responses to diagnosis, apparently to obtain perspective before progressing to treatment. However, resistance was not always addressed and prognosis was often avoided. Doctors highlighted pressure to make diagnoses and an aim to emphasise “living well” rather than discussing prognosis. Conclusion: The findings of this study highlighted the delicate balance between minimising likely resistance and distress and maximising understanding in the context of cognitive impairment. Instilling hope is evidently a priority for doctors. The diagnosis meeting is just one part of the journey of the person with dementia, and sufficient pre- and post-diagnosis support is integral.

Este estudo investigou os indicativos de resiliência parental no processo de comunicação do diagnóstico de autismo após a avaliação do filho. Esses indicativos representaram o construto da elaboração parental do diagnóstico de autismo. O objetivo do primeiro estudo foi a construção de uma matriz de categorias indicativas de resiliência parental baseada em análise de conteúdo de seis entrevistas de casais com um filho com diagnóstico de autismo. Essa matriz foi base conceitual e empírica do Estudo 2, um estudo de caso cujos instrumentos foram quatro entrevistas de comunicação formal do diagnóstico com um casal de pais. Os objetivos deste foram compreender o papel das crenças dos pais na comunicação do diagnóstico do filho e investigar indicativos de resiliência parental que participaram do processo de elaboração do diagnóstico de autismo ao longo de quatro meses. Os resultados da Análise de Conteúdo apontaram a busca e atribuição de sentido ao jeito do filho e ao autismo como fatores de elaboração na comunicação do diagnóstico. Os resultados foram discutidos com base na concepção do construto de elaboração parental do diagnóstico de autismo. / This study investigated the indicatives of parental resilience in the process of communicating the diagnosis of autism. These indications represented the construct of parental elaboration of autism diagnosis by the parents. The goal of the first investigation was to build an array of categories indicating parental resilience based on content analysis of six interviews drawn from a database. This was the empirical and conceptual bases of the parents elaborations of the diagnostic, investigated on the second study. The goals of the second investigation were to understand the role of the beliefs of these parents in the communication of the diagnosis and to investigate parental resilience indicatives that participated in the process of elaboration of the diagnosis of autism of this couple over four months. The results of the Content Analysis showed the search and attribution of meaning to the characteristics of the son, and to autism as key indicators of elaboration during the communication of the diagnosis. The results were discussed on the base of building the construct of autism diagnostic elaboration by the parents.

Este estudo investigou os indicativos de resiliência parental no processo de comunicação do diagnóstico de autismo após a avaliação do filho. Esses indicativos representaram o construto da elaboração parental do diagnóstico de autismo. O objetivo do primeiro estudo foi a construção de uma matriz de categorias indicativas de resiliência parental baseada em análise de conteúdo de seis entrevistas de casais com um filho com diagnóstico de autismo. Essa matriz foi base conceitual e empírica do Estudo 2, um estudo de caso cujos instrumentos foram quatro entrevistas de comunicação formal do diagnóstico com um casal de pais. Os objetivos deste foram compreender o papel das crenças dos pais na comunicação do diagnóstico do filho e investigar indicativos de resiliência parental que participaram do processo de elaboração do diagnóstico de autismo ao longo de quatro meses. Os resultados da Análise de Conteúdo apontaram a busca e atribuição de sentido ao jeito do filho e ao autismo como fatores de elaboração na comunicação do diagnóstico. Os resultados foram discutidos com base na concepção do construto de elaboração parental do diagnóstico de autismo. / This study investigated the indicatives of parental resilience in the process of communicating the diagnosis of autism. These indications represented the construct of parental elaboration of autism diagnosis by the parents. The goal of the first investigation was to build an array of categories indicating parental resilience based on content analysis of six interviews drawn from a database. This was the empirical and conceptual bases of the parents elaborations of the diagnostic, investigated on the second study. The goals of the second investigation were to understand the role of the beliefs of these parents in the communication of the diagnosis and to investigate parental resilience indicatives that participated in the process of elaboration of the diagnosis of autism of this couple over four months. The results of the Content Analysis showed the search and attribution of meaning to the characteristics of the son, and to autism as key indicators of elaboration during the communication of the diagnosis. The results were discussed on the base of building the construct of autism diagnostic elaboration by the parents.

Este estudo investigou os indicativos de resiliência parental no processo de comunicação do diagnóstico de autismo após a avaliação do filho. Esses indicativos representaram o construto da elaboração parental do diagnóstico de autismo. O objetivo do primeiro estudo foi a construção de uma matriz de categorias indicativas de resiliência parental baseada em análise de conteúdo de seis entrevistas de casais com um filho com diagnóstico de autismo. Essa matriz foi base conceitual e empírica do Estudo 2, um estudo de caso cujos instrumentos foram quatro entrevistas de comunicação formal do diagnóstico com um casal de pais. Os objetivos deste foram compreender o papel das crenças dos pais na comunicação do diagnóstico do filho e investigar indicativos de resiliência parental que participaram do processo de elaboração do diagnóstico de autismo ao longo de quatro meses. Os resultados da Análise de Conteúdo apontaram a busca e atribuição de sentido ao jeito do filho e ao autismo como fatores de elaboração na comunicação do diagnóstico. Os resultados foram discutidos com base na concepção do construto de elaboração parental do diagnóstico de autismo. / This study investigated the indicatives of parental resilience in the process of communicating the diagnosis of autism. These indications represented the construct of parental elaboration of autism diagnosis by the parents. The goal of the first investigation was to build an array of categories indicating parental resilience based on content analysis of six interviews drawn from a database. This was the empirical and conceptual bases of the parents elaborations of the diagnostic, investigated on the second study. The goals of the second investigation were to understand the role of the beliefs of these parents in the communication of the diagnosis and to investigate parental resilience indicatives that participated in the process of elaboration of the diagnosis of autism of this couple over four months. The results of the Content Analysis showed the search and attribution of meaning to the characteristics of the son, and to autism as key indicators of elaboration during the communication of the diagnosis. The results were discussed on the base of building the construct of autism diagnostic elaboration by the parents.

No / Fault management is one of the important management functions of a telecommunication network and mainly deals with fault monitoring and diagnosis. This paper applies reliability theories and methodologies for the fault management of an aeronautical communication system developed within the EU FP7 SANDRA project. The failure of the SANDRA terminal demonstrator is an undesirable event and the corresponding fault tree was built upon a reliability function analysis and was used to quickly monitor failures in the system. By using Monte Carlo simulations, the SANDRA demonstrator's reliability can be predicted and important components, which have major contributions to system failures, can be identified. The results can be used to improve the system reliability by adding parallel components in weak and important places. / Fault management is one of the important management functions of a telecommunication network and mainly deals with fault monitoring and diagnosis. This paper applies reliability theories and methodologies for the fault management of an aeronautical communication system developed within the EU FP7 SANDRA project. The failure of the SANDRA terminal demonstrator is an undesirable event and the corresponding fault tree was built upon a reliability function analysis and was used to quickly monitor failures in the system. By using Monte Carlo simulations, the SANDRA demonstrator's reliability can be predicted and important components, which have major contributions to system failures, can be identified. The results can be used to improve the system reliability by adding parallel components in weak and important places.