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Medical Encounters (medical + encounter)
Selected AbstractsPrevalence of epilepsy and seizures in the Navajo Nation 1998,2002EPILEPSIA, Issue 10 2009Karen Parko Summary Purpose:, To determine the prevalence of epilepsy and seizures in the Navajo. Methods:, We studied 226,496 Navajo residing in the Navajo Reservation who had at least one medical encounter between October 1, 1998 and September 30, 2002. We ascertained and confirmed cases in two phases. First, we identified patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes signifying epilepsy or seizures using Indian Health Service (IHS) administrative data. Second, we reviewed medical charts of a geographic subpopulation of identified patients to confirm diagnoses and assess the positive predictive value of the ICD-9-CM codes in identifying patients with active epilepsy. Results:, Two percent of Navajo receiving IHS care were found to have an ICD-9-CM code consistent with epilepsy or seizures. Based on confirmed cases, the crude prevalence for the occurrence of any seizure (including febrile seizures and recurrent seizures that may have been provoked) in the geographic subpopulation was 13.5 per 1,000 and the crude prevalence of active epilepsy was 9.2 per 1,000. Prevalence was higher among males, children under 5 years of age, and older adults. Discussion:, The estimated prevalence of active epilepsy in the Navajo Nation is above the upper limit of the range of reported estimates from other comparable studies of U.S. communities. [source] Patients' perceptions of cultural factors affecting the quality of their medical encountersHEALTH EXPECTATIONS, Issue 1 2005Anna M. Nápoles-Springer PhD Abstract Objective, The aim of this study was to identify key domains of cultural competence from the perspective of ethnically and linguistically diverse patients. Design, The study involved one-time focus groups in community settings with 61 African,Americans, 45 Latinos and 55 non-Latino Whites. Participants' mean age was 48 years, 45% were women, and 47% had less than a high school education. Participants in 19 groups were asked the meaning of ,culture' and what cultural factors influenced the quality of their medical encounters. Each text unit (TU or identifiable continuous verbal utterance) of focus group transcripts was content analysed to identify key dimensions using inductive and deductive methods. The proportion of TUs was calculated for each dimension by ethnic group. Results, Definitions of culture common to all three ethnic groups included value systems (25% of TUs), customs (17%), self-identified ethnicity (15%), nationality (11%) and stereotypes (4%). Factors influencing the quality of medical encounters common to all ethnic groups included sensitivity to complementary/alternative medicine (17%), health insurance-based discrimination (12%), social class-based discrimination (9%), ethnic concordance of physician and patient (8%), and age-based discrimination (4%). Physicians' acceptance of the role of spirtuality (2%) and of family (2%), and ethnicity-based discrimination (11%) were cultural factors specific to non-Whites. Language issues (21%) and immigration status (5%) were Latino-specific factors. Conclusions, Providing quality health care to ethnically diverse patients requires cultural flexibility to elicit and respond to cultural factors in medical encounters. Interventions to reduce disparities in health and health care in the USA need to address cultural factors that affect the quality of medical encounters. [source] The interpreter as institutional gatekeeper: The social-linguistic role of interpreters in Spanish-English medical discourseJOURNAL OF SOCIOLINGUISTICS, Issue 3 2000Brad Davidson Increases in immigration have led to an enormous growth in the number of cross-linguistic medical encounters taking place throughout the United States. In this article the role of hospital-based interpreters in cross-linguistic, internal medicine ,medical interviews' is examined. The interpreter's actions are analyzed against the historical and institutional context within which she is working, and also with an eye to the institutional goals that frame the patient-physician discourse. Interpreters are found not to be acting as ,neutral' machines of semantic conversion, but are rather shown to be active participants in the process of diagnosis. Since this process hinges on the evaluation of social and medical relevance of patient contributions to the discourse, the interpreter can be seen as an additional institutional gatekeeper for the recent immigrants for whom she is interpreting. Cross-linguistic medical interviews may also be viewed as a form of cross-cultural interaction; in this light, the larger political ramifications of the interpreters' actions are explored. ,Interpreters are the most powerful people in a medical conversation.' Head of Interpreting Services at a major private U.S. hospital, May 1999. [source] Doctor,Patient Gender Concordance and Patient Satisfaction in Interpreter-Mediated Consultations: An Exploratory StudyJOURNAL OF TRAVEL MEDICINE, Issue 1 2008Alexander Bischoff PhD Background Research suggests that doctor,patient communication patterns and patient satisfaction are influenced by gender. However, little is known about the effect of gender in consultations with foreign language,speaking patients and in interpreter-mediated consultations. Methods The objective of the study was to explore the effect of doctor,patient gender concordance on satisfaction of foreign language,speaking patients in consultations with and without a professional interpreter. Its design consists of a cross-sectional analysis of patients' reports. A total of 363 consultations with foreign language,speaking patients were included in the analysis. We measured the mean scores of six items on the quality of communication (answer scale 0,10): the doctor's response to the patient's needs, the doctors' explanations, the doctor's respectfulness toward the patient, the quality of communication in general, the overall consultation process, and information provided regarding follow-up. Results When interpreters were used, mean scores were similar for doctor,patient concordant and discordant pairs. However, in the absence of interpreters, doctor,patient gender discordance was associated with lower overall ratings of the quality of communication (,0.46, p= 0.01). Conclusions Our results suggest that the presence of a professional interpreter may reduce gender-related communication barriers during medical encounters with foreign language,speaking patients. [source] Evaluating medical students' non-verbal communication during the objective structured clinical examinationMEDICAL EDUCATION, Issue 12 2006Hirono Ishikawa Objectives, Non-verbal communication (NVC) in medical encounters is an important method of exchanging information on emotional status and contextualising the meaning of verbal communication. This study aimed to assess the impact of medical students' NVC on interview evaluations by standardised patients (SPs). Methods, A total of 89 medical interviews in an objective structured clinical examination (OSCE) for post-clerkship medical students were analysed. All interviews were videotaped and evaluated on 10 non-verbal behaviour items. In addition, the quality of the interview content was rated by medical faculty on 5 items and the interview was rated by SPs on 5 items. The relationships between student NVC and SP evaluation were examined by multivariate regression analyses controlling for the quality of the interview content. Results, Standardised patients were likely to give higher ratings when students faced them directly, used facilitative nodding when listening to their talk, looked at them equally when talking and listening, and spoke at a similar speed and voice volume to them. These effects of NVC remained significant after controlling for the quality of the interview content. Conclusions, This study provided evidence of specific non-verbal behaviours of doctors that may have additional impacts on the patient's perception of his or her visit, independently of the interview content. Education in basic NVC should be incorporated into medical education alongside verbal communication. [source] Theme-oriented discourse analysis of medical encountersMEDICAL EDUCATION, Issue 6 2005Celia Roberts Approach, Theme-oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is negotiated in interaction. Detailed features of talk, such as intonation and choice of vocabulary, trigger inferences about what is going on and being talked about. These affect how interactants judge each other and decisions are made. Interactions also have larger rhetorical patterns used by both patients and doctors to persuade each other. Examples, Two settings are used to illustrate this approach: genetic counselling and primary care consultations in multilingual areas. In genetic counselling, interactions are organised around the tension between the risks of knowing and the risks of occurrence. This can lead to a ,rhetorical duel' between health professionals and patients and their families. In intercultural primary care settings, talk itself may be the problem when interpretive processes cannot be taken for granted. Even widely held models of good practice can lead to misunderstandings under these conditions. Conclusion, Through discourse analysis, the talk under scrutiny can be slowed down to show the interpretive processes and overall patterns of an activity. Discourse analysts and health professionals, working together, can look at problems in new ways and develop interventions and tools for a better understanding of communication in medical life. [source] Original Article: Consequences in women of participating in a study of the natural history of cervical intraepithelial neoplasia 3AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Margaret R.E. MCCREDIE Background:, A retrospective cohort study was performed in 1063 women diagnosed with cervical intraepithelial neoplasia grade 3 (CIN3) (previously termed carcinoma in situ, CIS) in the National Women's Hospital, Auckland, New Zealand. The study describes the clinical management and outcomes for women with CIN3 diagnosed in the decade of 1965,1974, when treatment with curative intent was withheld in an unethical clinical study of the natural history of CIS. A comparison is made with women who were diagnosed earlier (1955,1964) and later (1975,1976). Aims:, The aim of the study is to record the medical encounters, frequency and management of cytological abnormalities and the occurrence of invasive cancers. The medical records, cytology and histopathology were reviewed and data linked with cancer and death registers. Results:, Women diagnosed with CIN3 in 1965,1974 (n = 422), compared with those diagnosed earlier (n = 385) or later (n = 256): (i) were less likely to have initial treatment with curative intent (51% vs 95 and 85%, respectively); (ii) had more follow-up biopsies (P < 0.0005); (iii) were more likely to have positive cytology during follow-up (P < 0.005) and positive smears that were not followed within six months by a treatment with curative intent (P < 0.005); and (iv) experienced a higher risk of cancer of the cervix or vaginal vault (RR = 3.3 compared with the first period, 95% CI: 1.7,5.3). Among women diagnosed in 1965,1974, those initially managed by punch or wedge biopsy alone had a cancer risk ten times (95% CI: 3.9,25.7) higher than women initially treated with curative intent. Conclusions:, During the ,clinical study' (1965,1974), women underwent numerous interventions that were aimed to observe rather than treat their condition, and their risk of cancer was substantially increased. [source] Racial differences in trust and regular source of patient care and the implications for prostate cancer screening use,CANCER, Issue 21 2009William R. Carpenter PhD Abstract BACKGROUND: Nonmedical factors may modify the biological risk of prostate cancer (PCa) and contribute to the differential use of early detection; curative care; and, ultimately, greater racial disparities in PCa mortality. In this study, the authors examined patients' usual source of care, continuity of care, and mistrust of physicians and their association with racial differences in PCa screening. METHODS: Study nurses conducted in-home interviews of 1031 African-American men and Caucasian-American men aged ,50 years in North Carolina and Louisiana within weeks of their PCa diagnosis. Medical records were abstracted, and the data were used to conduct bivariate and multivariate analyses. RESULTS: Compared with African Americans, Caucasian Americans exhibited higher physician trust scores and a greater likelihood of reporting a physician office as their usual source of care, seeing the same physician at regular medical encounters, and historically using any PCa screening. Seeing the same physician for regular care was associated with greater trust and screening use. Men who reported their usual source of care as a physician office, hospital clinic, or Veterans Administration facility were more likely to report prior PCa screening than other men. In multivariate regression analysis, seeing the same provider remained associated with prior screening use, whereas both race and trust lost their association with prior screening. CONCLUSIONS: The current results indicated that systems factors, including those that differ among different sources of care and those associated with the continuity of care, may provide tangible targets to address disparities in the use of PCa early detection, may attenuate racial differences in PCa screening use, and may contribute to reduced racial disparities in PCa mortality. Cancer 2009. Published 2009 by the American Cancer Society. [source] Anticipating Demand for Emergency Health Services due to Medication-related Adverse Events after Rapid Mass Prophylaxis CampaignsACADEMIC EMERGENCY MEDICINE, Issue 3 2007Nathaniel Hupert MD Objectives: Mass prophylaxis against infectious disease outbreaks carries the risk of medication-related adverse events (MRAEs). The authors sought to define the relationship between the rapidity of mass prophylaxis dispensing and the subsequent demand for emergency health services due to predictable MRAEs. Methods: The authors created a spreadsheet-based computer model that calculates scenario-specific predicted daily MRAE rates from user inputs by applying a probability distribution to the reported timing of MRAEs. A hypothetical two- to ten-day prophylaxis campaign for one million people using recent data from both smallpox vaccination and anthrax chemoprophylaxis campaigns was modeled. Results: The length of a mass prophylaxis campaign plays an important role in determining the subsequent intensity in emergency services utilization due to real or suspected adverse events. A two-day smallpox vaccination scenario would produce an estimated 32,000 medical encounters and 1,960 hospitalizations, peaking at 5,246 health care encounters six days after the start of the campaign; in contrast, a ten-day campaign would lead to 41% lower peak surge, with a maximum of 3,106 encounters on the busiest day, ten days after initiation of the campaign. MRAEs with longer lead times, such as those associated with anthrax chemoprophylaxis, exhibit less variability based on campaign length (e.g., 124 out of an estimated 1,400 hospitalizations on day 20 after a two-day campaign versus 103 on day 24 after a ten-day campaign). Conclusions: The duration of a mass prophylaxis campaign may have a substantial impact on the timing and peak number of clinically significant MRAEs, with very short campaigns overwhelming existing emergency department (ED) capacity to treat real or suspected medication-related injuries. While better reporting of both incidence and timing of MRAEs in future prophylaxis campaigns should improve the application of this model to community-based emergency preparedness planning, these results highlight the need for coordination between public health and emergency medicine planning for infectious disease outbreaks to avoid preventable surges in ED utilization. [source] | ||||||||||