Home About us Contact
|
Home About us Contact | ||
|
|
||
Medical Consultation (medical + consultation)
Selected AbstractsRhabdomyosarcoma of the mandible in a 6-year-old boyINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2006L. E. DAVIDSON Summary., Introduction., Rhabdomyosarcoma is an aggressive malignant tumour composed of neoplastic mesenchymal cells that infiltrate surrounding tissue structures, making their precise site of origin unclear. Although rare, this is highly aggressive and the most common soft-tissue neoplasm of the head and neck in children. Regrettably by the time most cases are initially seen, the patients already have large tumours, due to rapid tumour growth and delayed medical consultation. Case Report., This report describes a 6-year-old presenting with just such symptoms of facial swelling and pain but elicitation of further information and findings, including tooth mobility of 3 days duration, led to prompt referral and early treatment of an embryonal rhabdomyosarcoma. Conclusion., General dental practitioners are frequently presented with a child with a swollen face and pain. Experience would suggest a dental abscess to be the most likely cause with treatment as appropriate. However, all swellings in children, should be thoroughly investigated and reviewed as particularly in this age group, tumour growth is rapid while early diagnosis allows successful treatment with multimodality therapy. [source] Influence exerted on drug prescribing by patients' attitudes and expectations and by doctors' perception of such expectations: a cohort and nested case-control studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2008Eugenia Lado BS Abstract Rationale, aims and objectives, Although demand for medication is regarded as one of the most important factors in pharmaceutical expenditure, little is known about patients' influence on drug prescribing. This study assesses the influence exerted on drug prescribing by patients' attitudes and expectations, and by doctors' perception of such expectations. Method, We conducted a population-based cohort study covering 937 subjects attending a health centre in the northwest of Spain. Prescription-drug advertising directly targeted at patients is banned in Spain. We conducted home-based interviews at the start of follow-up to assess patients' attitudes, and monthly telephone interviews during the 1-year follow-up period to assess consumption of medical drugs and medical visits. Using nested case-control study covering 127 of the cohort subjects who attended the health centre, we assessed patients' pre-consultation expectations for prescriptions, doctors' perception of such patients' expectations, and the drugs actually prescribed. Results, Of the total sample, 69.3% answered the home-based questionnaire, 77.6% completed 11 or more months of follow-up, and 100% of cohort subjects who attended the health centre responded to the pre-consultation survey conducted in the waiting room. Patients' attitudes, though not associated with prescription (P > 0.1), were, however, associated with demand for medical consultation (P < 0.01), self-medication (P < 0.01) and prescription expectations (P < 0.01). Although doctors' perception of patients' expectations did indeed show an association with drug prescribing (P = 0.001), there was no association between patients' expectations and doctors' perception of such expectations (P > 0.1), as these tended to be overestimated by doctors. Conclusion, We conclude that, although doctors prescribe in accordance with what they believe their patients expect, in practice patients exert no influence on drug prescribing because their prescription expectations are misconstrued by doctors, who overestimate them. [source] Epidemiology of irritable bowel syndrome in Asia: Something old, something new, something borrowedJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2009Kok-Ann Gwee Abstract In this review we have unearthed epidemiological data that; support the ,old' concept of irritable bowel syndrome (IBS) as a disorder of civilization, build a ,new' symptom profile of IBS for Asia, and persuade us against the use of ,borrowed' Western diagnostic criteria and illness models by Asian societies. In the 1960s, IBS was described as a disorder of civilization. Early studies from Asia suggested a prevalence of IBS below 5%. Recent studies from Asia suggest a trend for the more affluent city states like Singapore and Tokyo, to have higher prevalence of 8.6% and 9.8%, respectively, while India had the lowest prevalence of 4.2%. Furthermore, there was a trend among the better educated and more affluent strata of society in several urban Chinese populations for a higher prevalence of IBS, as well as a trend for a higher consultation rate. Across Chinese and Indian predominant populations, a majority of patients with IBS criteria report upper abdominal symptoms such as epigastric pain relieved by defecation, bloating and dyspepsia. Bloating and incomplete evacuation appear to be more important determinants of consultation behavior, than psychological factors. The failure of the Rome criteria to recognize the relationship to meals, may have led to a substantial misclassification of IBS as dyspepsia. The relevance of the Western model of psychological disturbance as a determinant of consultation behavior is questionable because of the accessibility and acceptability of medical consultation for gastrointestinal complaints in many Asian communities. [source] Factors influencing parental decision to consult for children with upper respiratory tract infectionJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2008Chirk-Jenn Ng Aim: This study aimed to determine which factors could influence (i) parents' decision to seek medical consultatin and (ii) their preference for either public or private medical service in children with upper respiratory tract infection. Methods: This cross-sectional study was conducted at the Gombak district, which is an urban area in Malaysia. We randomly selected parents of kindergarten children aged 4,5 years to participate in this questionnaire survey. The main outcome measures were predictors of early medical consultation and type of service utilisation (public versus private). Results: We achieved a response rate of 84.5% (n = 1033/1223). 64.1% sought early medical consultation and 70.9% preferred to consult a private doctor. Early consultation was predicated by the parent gender being male (OR 1.50; 95% CI 1.09, 2.05), non-Chinese (OR 1.75%; 95% CI 1.10, 2.79), and those who preferred child specialists (OR 2.02; 95% CI 1.27, 3.23). Lower income group (OR 4.28; 95% CI 2.30, 7.95) and not having a regular doctor (OR 4.99%; 95% CI 3.19, 7.80) were predictors of using the public health services. Conclusions: Parent's gender, ethnicity and income influenced their decision to seek early medical consultation for their children's respiratory illness while income and having a regular doctor could predict their choice of healthcare services. [source] Factors associated with childhood constipationJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 10 2007Mustafa Inan Aim: To evaluate factors associated with constipation, determine its risk factors and identify common methods of managing constipation among schoolchildren from ages 7,12 in Edirne, Turkey. Methods: This was a cross-sectional and descriptive study and 1900 children were stratified by the school population, age and gender. The questionnaire collected information from parents about the prevalence of constipation and associated factors as well. It asked about bowel movements, socio-demographic data, personal and family stressors, parental concern about constipation, and treatment methods. Results: The overall prevalence of constipation was 7.2%. It was 7.3% in boys and 7.2% in girls (P > 0.05). The parameters of siblings with health problems, constipation history in family members, abnormal oral habits, and little regular sporting activity were more common in constipated children than in non-constipated ones (P < 0.05). In the logistic regression analysis, never having used school toilets (OR: 5.9) and having problem to control their bowel after 2 years of age (OR: 3.1) were found to be major risk factors for constipation in schoolchildren ages 7,12 years. Constipated children had a lower consumption rate of fruits and vegetables and a higher consumption rate of milk-group foods, biscuits and macaroni than non-constipated children. Parental concern was at 90% and the rate of medical consultation was 23.2% for constipated children. Conclusions: The risk factors for childhood constipation may be genetic, psychological or organic. Bowel functions may be affected by dietary habits. Parents, health and education professionals should give special attention to childhood constipation. [source] Patterns of medication use in the immigrant population resident in Spain: associated factorsPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2009P. Carrasco-Garrido PhD Abstract Purpose This study mainly aimed at to ascertain to ascertain the prevalence of the consumption of medications, prescribed and self-medicated, among the immigrant population (economic immigrants and not economic immigrants) resident in Spain, and to identify the factors associated with such consumption in this population. Methods We have worked with individualized secondary data, collected in the Spanish National Health Survey carried out in 2006 and 2007 (SNHS-06), from the Ministry of Health and Consumer Affairs. A total of 2055 subjects born outside Spain, aged 16 years or over, were analysed. The independent variables were sociodemographic and health-related, and the dependent variable was medication use. Using logistic multivariate regression models we have estimated the independent effect of each of these variables on the medication consumption. Results The 55.8% of immigrant population responded affirmatively to having consumed some type of medication. The drugs that registered the highest consumption prevalence were analgesics (53.09%). It should be stressed here that 8.75% of the not economic immigrant population has consumed antibiotics. The variables that were independently and significantly associated with a greater probability of medication consumption were: sex, age, presence of chronic disease, use of alternative medicines and a negative perception of health. The most strongly associated variable is medical consultation. Conclusions The prevalence of medication use higher among economic immigrant women. In our population, the use of alternative medicines use and medical visits to the physician are associated with higher consumption. Copyright © 2009 John Wiley & Sons, Ltd. [source] How important is consent in maternal serum screening for Down syndrome in France?PRENATAL DIAGNOSIS, Issue 3 2007Information, consent evaluation in maternal serum screening for Down syndrome: a French study Abstract Objectives To evaluate the level of information and informed consent for maternal serum screening (MSS) for Down syndrome (DS) in the second trimester of pregnancy and analyse the exercise of autonomy towards the test by the women concerned. Methods We studied the population of pregnant women attending obstetric consultations in two French hospitals over a 3-month period. The women were assigned to three groups according to MSS results for DS: women at high risk of having a child with DS (group 1), women at low risk (group 2) and women who did not undergo the test (group 3). A questionnaire was completed before the medical consultation, to assess the quality of consent before amniocentesis for the group at high risk and before the second-trimester ultrasound scan for the other two groups. Results We analysed 305 questionnaires for 89, 137 and 79 women belonging to groups 1, 2 and 3 respectively. In total, 123 women (40.3% [IC 95%, 35,46%]) were considered to be well informed; 33 (10%, [IC 95%, 8,12%]) had a high level of knowledge, but made choices not consistent with their stated attitude, and 149 (49.7% [IC 95%, 45,56%]) were considered uninformed. Logistic regression analysis showed that maternal consent depended on three independent components: The score attributed to the doctor for information about MSS (t = 4.216, p < 0.001). Whether the patient belonged to group 1 (t = ,2.631, p < 0.009). Educational level (< high-school diploma, high-school diploma or at least two years of higher education after high school) (t = 2.324, p < 0.02). The rate of consent increased with educational level and was highest for the women in group 1 and for those whose doctor had a high information score. Conclusions Our findings clearly show that women are provided with insufficient information concerning MSS screening for DS in the second trimester of pregnancy for real and valid consent to be obtained. Copyright © 2007 John Wiley & Sons, Ltd. [source] Medical diagnostic consultation concerning mental retardation: An analogue study of school psychologists' attitudesPSYCHOLOGY IN THE SCHOOLS, Issue 3 2010David L. Wodrich Recent research of relevance to school psychologists suggests that the cause, or etiology, of mental retardation can be established by medical diagnosticians in approximately one-half of cases. In the current study, 109 practicing school psychologists considered a hypothetical case of an elementary student with mental retardation and indicated their attitudes toward the use of medical consultation. School psychologists were randomly assigned to one of three experimental conditions defined by the amount of information about medical diagnostic consultations they received: (a) no information, (b) guidelines from the American Academy of Neurology (AAN) calling for medical consultation in cases of developmental delay, or (c) AAN guidelines plus a concise summary of research on etiology, prevention, and mental retardation. School psychologists with more than 10 years of experience evidenced a more favorable attitude toward medical diagnostic consultation when provided more information, whereas their less experienced colleagues demonstrated no such pattern. This finding, together with others derived from participants' responses, is discussed regarding school psychologists' practice and training. © 2010 Wiley Periodicals, Inc. [source] Nurse-Midwives' Experiences with Planned Home Birth: Impact on Attitudes and PracticeBIRTH, Issue 4 2009Saraswathi Vedam RM, SciD(h.c.) ABSTRACT: Background: Health care providers' attitudes toward maternity care options influence the nature of informed decision-making discussions and patient choice. A woman's choice of birth site may be affected by her provider's opinion and practice site. The objectives of this study were to describe American nurse-midwives' attitudes toward, and experiences with, planned home birth, and to explore correlates and predictors of their attitudes toward planned home birth as measured by the Provider Attitudes towards Planned Home Birth (PAPHB) scale.Methods: A survey instrument, which incorporates the PAPHB and assesses demographic, education, practice, personal experience, and external barrier variables that may predict attitudes toward planned home birth practice, was completed by 1,893 nurse-midwives. Bivariate analysis identified associations between variables and attitudes. Linear regression modeling identified predictors of attitudes.Results: Variables that significantly predicted favorable attitudes to planned home birth were increased clinical and educational experiences with planned home birth (p < 0.001), increased exposure to planned home birth (p < 0.001), and younger age (p < 0.001). External barriers that significantly predicted less favorable attitudes included financial (p = 0.03) and time (p < 0.001) constraints, inability to access medical consultation (p < 0.001), and fear of peer censure (p < 0.001). Willingness to practice in the home was correlated with factors related to nurse-midwives' confidence in their management abilities and beliefs about planned home birth safety.Conclusions: The results suggest that nurse-midwives' choice of practice site and comfort with planned home birth are strongly influenced by the nature and amount of exposure to home birth during professional education or practice experiences, in addition to interprofessional, logistic, and environmental factors. Findings from this research may inform interdisciplinary education and collaborative practice in the area of planned home birth. [source] Racial differences in diagnosis, treatment, and clinical delays in a population-based study of patients with newly diagnosed breast carcinoma,,CANCER, Issue 8 2004Karin Gwyn M.D., M.P.H. Abstract BACKGROUND Few studies have addressed the issue of whether delays in the interval between medical consultation and the diagnosis and treatment of breast carcinoma are greater for African American women than for white women. The authors examined differences with respect to these delays and analyzed the factors that may have contributed to such differences among women ages 20,54 years who had invasive breast carcinoma diagnosed between 1990 and 1992 and who lived in Atlanta, Georgia. METHODS A total of 251 African American women and 580 white women were interviewed and had their medical records reviewed. The authors estimated racial differences in delay times and used polytomous logistic regression to determine the contributions of various factors (socioeconomic and other) to these differences. RESULTS Although most women in both groups were treated within 3 months of initial consultation, 22.4% of African American women and 14.3% of white women had clinical delays of > 3 months. Compared with white women, African American women were more likely to experience delays in diagnosis and treatment. Access to care (as represented by method of detection and insurance status) and poverty index partially accounted for these differences in delay time; however, racial differences in terms of delayed treatment and diagnosis remained even after adjustment for contributing factors. CONCLUSIONS The findings of the current study suggest that among women ages 20,54 years who have breast carcinoma, potentially clinically significant differences in terms of delayed diagnosis and treatment exist between African American women and white women. Improvements in access to care and in socioeconomic circumstances may address these differences to some degree, but additional research is needed to identify other contributing factors. Cancer 2004. Published 2004 American Cancer Society. [source] The cost of cataract patients awaiting surgeryACTA OPHTHALMOLOGICA, Issue 6 2000Ulf Stenevi ABSTRACT. Purpose: To describe the cost for society services caused by the patients awaiting surgery for one year in Gothenburg, 1997. Methods: From a waiting list of 1458 patients awaiting cataract surgery 250 randomly selected patients were interviewed. The structured questions focused on community services, such as home help, subsidised travel by taxi, medical treatment at home, visual aids, hospital stay and medical consultation, caused by the cataract symptoms. Results: The total cost for the community for the 1 458 patients awaiting surgery was an estimated SEK 5 200 000. Hospital stay and home help were the largest parts of this community expense. Conclusion: The direct costs for society for one year caused by 1 458 patients awaiting cataract surgery with a mean waiting time of 9.8 months was approximately the same as operating 800 patients (eyes). [source] Reasons for visiting Polish primary care practices by patients aged 18,44 years: the largest emigrating age groupHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2009Magdalena Ignaszak-Szczepaniak MD PhD Abstract Over 3% of the entire Polish population migrate for a job within the European Union, most are aged 18,44 years. The main destinations are Germany, the United Kingdom and Ireland. Immigration is connected with the use of many public services, including healthcare services. Assuming Polish immigrants require medical consultations in the countries they reside in, the authors have analysed the reasons for patients' visits to general practitioners (GPs) in Poland in order to predict possible reasons why Polish patients living abroad may make appointments with GPs in other countries. Data from 22 769 visits to GP practices between June 2005 and May 2006 by Polish patients aged 18,44 years were collected electronically. Age was categorised into three groups (18,24, 25,34 and 35,44 years) and the reason for the visit was categorised according to the ICD 10 coding system. Among the 12 535 patients registered with GPs, 73.1% of women and 68.6% of men required consultations during the year the study was conducted. The highest percentage of visits was recorded for women aged 35,44 years, while men of the same age were the least likely to visit a GP. The mean number of visits per patient ranged from 1.89 for men aged 25,34 years to 3.11 for women aged 35,44 years. The means were similar for 18- to 24-year-old men and women. Women aged 35,44 years had a higher mean number of visits compared with women aged 18,24 years, whereas the opposite was true for men. The analysis of reasons for visits within the age groups indicated that the percentage of appointments for respiratory problems and general and unspecified problems dropped by more than half from the 18,24-year-olds to the 35,44-years-olds, while visits for musculosceletal, cardiovascular, and mental and behavioural problems increased by a factor of four. The presented results intend to enable healthcare services meet Polish immigrants' healthcare needs. [source] Patient involvement in clinical decision making: the effect of GP attitude on patient satisfactionHEALTH EXPECTATIONS, Issue 2 2006Benedicte Carlsen Cand. Abstract Objective, This study investigates general practitioners' (GPs) and patients' attitudes to shared decision making, and how these attitudes affect patient satisfaction. Background, Sharing of information and decisions in the consultation is largely accepted as the ideal in general practice. Studies show that most patients prefer to be involved in decision making and shared decision making is associated with patient satisfaction, although preferences vary. Still we know little about how the interaction of GP and patients' attitudes affects patient satisfaction. One such study was conducted in the USA, but comparative studies are lacking. Design, Questionnaire survey distributed through GPs. Setting and participants, The results are based on the combined questionnaires of 41 GPs and 829 of their patients in the urban municipality of Bergen in the western part of Norway. Main variables studied, The data were collected using a nine-item survey instrument constructed to measure attitudes towards patient involvement in medical consultations. The patients were also asked to rate their satisfaction with their GP. Results and conclusions, The patients had a strong preference for shared decision making. The GPs also generally preferred shared decision making, but to a lesser degree than the patients, which is the opposite of the findings of the US study. There was a positive effect of the GP's attitude towards shared decision making on patient satisfaction, but no significant effect of congruence of attitudes between patient and GP on patient satisfaction. The suggested explanation is that GPs that are positive to sharing decisions are more responsive to patients' needs and therefore satisfy patients even when the patient's attitude differs from the GPs' attitude. Hence, although some patients do prefer a passive role, it is important to promote positive attitudes towards patient involvement in medical consultations. [source] A Primer on Multilevel ModelingHUMAN COMMUNICATION RESEARCH, Issue 4 2006Andrew F. Hayes Multilevel modeling (MLM) is growing in use throughout the social sciences. Although daunting from a mathematical perspective, MLM is relatively easy to employ once some basic concepts are understood. In this article, I present a primer on MLM, describing some of these principles and applying them to the analysis of a multilevel data set on doctor,patient communication during medical consultations. [source] Appropriate use of non-prescription ibuprofen: a survey of patients' perceptions and understandingINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2010Suong N. T. Ngo Abstract Objectives The aim was to investigate patients' perceptions and understanding on the appropriate use of non-prescription ibuprofen. Methods In this pilot study, a self-administered anonymous survey was completed by 183 patients presenting at one of the eight selected community pharmacy premises in South Australia and the Northern Territory during the study. The questionnaire comprised items on: demographics (age, gender), current medications, frequency of ibuprofen use, medical consultations, reading manufacturer's printed dosage/warning instructions, sources from which drug information was gathered and understanding of common indications for ibuprofen. Key findings Sixty per cent of patients (n= 110/183), predominantly females, were currently on other medications and 64.5% of patients (n= 118/183) did not seek medical advice before using non-prescription ibuprofen. Seventy-one per cent (n= 130) of these patients had used ibuprofen for more than a year. The majority of patients did not provide precise answers for the common indications of ibuprofen. Sixty-six per cent of patients (n= 110) reported rarely or never reading manufacturer's printed warning instructions on the potential drug interactions or adverse effects associated with the use of the product. Conclusions Many patients are unaware that non-presciption analgesics such as ibuprofen can cause potentially serious adverse effects when used in combination with other common medications. [source] The dependent patient in a psychiatric inpatient setting: Relationship of interpersonal dependency to consultation and medication frequenciesJOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2001Richard M. O'Neill To examine the relationship between interpersonal dependency and medical service use in a hospital setting, the number of medical consultations and psychotropic medication prescriptions were compared in matched, mixed-sex samples of 40 dependent and 40 nondependent psychiatric inpatients. Results indicated that dependent patients received more medical consultations and a greater number of medications than did nondependent patients with similar demographic and diagnostic profiles. Implications of these results for theoretical models of interpersonal dependency and for previous research on the dependency,help-seeking relationship are discussed. Practical implications of these findings for work with dependent patients are summarized. © 2001 John Wiley & Sons, Inc. J Clin Psychol 57: 289,298, 2001. [source] Traumatic occupational injuries in Hispanic and foreign born workersAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2010Linda Forst MD Abstract Background Hispanic and foreign-born workers suffer high rates of occupational fatality. Reasons for this are not well understood. Our aim was to gather information about the details related to severe, non-fatal occupational injuries in this vulnerable population. Methods Eight years of data were obtained from an urban trauma center. In addition, medical consultations of individuals admitted for an occupational injury during an 8-month period are reported. Results Hispanics were more highly represented than expected; their number of injuries steadily rose. Hispanics were more likely to be injured by machinery and hand tools. Workers reported hazardous working conditions, lack of workers compensation, short time in current employment, and not working in their usual job. Conclusion Trauma systems can provide a glimpse of risk factors for severe injuries in vulnerable workers. We recommend greater use of this data source, follow backs, long-term follow up of individuals, and improvement of surveillance of vulnerable working populations. Am. J. Ind. Med. 53:344,351, 2010. © 2009 Wiley-Liss, Inc. [source] | |||||||||||||