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Selected AbstractsFinding and Using Health and Medical Information on the InternetHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 1 2002Wendy Roberts No abstract is available for this article. [source] Whither the sanctity and sanctuary of medical information?EMERGENCY MEDICINE AUSTRALASIA, Issue 3 2002Anthony FT Brown No abstract is available for this article. [source] Molecular evidence-based medicineEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 5 2007Evolution, integration of information in the genomic era Abstract Evidence-based medicine and molecular medicine have both been influential in biomedical research in the last 15 years. Despite following largely parallel routes to date, the goals and principles of evidence-based and molecular medicine are complementary and they should be converging. I define molecular evidence-based medicine as the study of medical information that makes sense of the advances of molecular biological disciplines and where errors and biases are properly appreciated and placed in context. Biomedical measurement capacity improves very rapidly. The exponentially growing mass of hypotheses being tested requires a new approach to both statistical and biological inference. Multidimensional biology requires careful exact replication of research findings, but indirect corroboration is often all that is achieved at best. Besides random error, bias remains a major threat. It is often difficult to separate bias from the spirit of scientific inquiry to force data into coherent and ,significant' biological stories. Transparency and public availability of protocols, data, analyses and results may be crucial to make sense of the complex biology of human disease and avoid being flooded by spurious research findings. Research efforts should be integrated across teams in an open, sharing environment. Most research in the future may be designed, performed, and integrated in the public cyberspace. [source] The enigma of Lenin's (1870,1924) maladyEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2004V. Lerner The health of heads of states is not always handled in the same way as an incapacitating disability in ordinary professionals. Instead of suspension of responsibilities, the health status of political leaders is concealed, especially when the illness is perceived as stigmatizing, such as organic mental impairment or sexual disorder. The objective of the present paper is to analyse the malady of Lenin (1870,1924) in the light of relevant and new medical information. It is hoped that this will accentuate the need for transparency when the health of a statesman is concerned. [source] Feature extraction by autoregressive spectral analysis using maximum likelihood estimation: internal carotid arterial Doppler signalsEXPERT SYSTEMS, Issue 4 2008Elif Derya Übeyli Abstract: In this study, Doppler signals recorded from the internal carotid artery (ICA) of 97 subjects were processed by personal computer using classical and model-based methods. Fast Fourier transform (classical method) and autoregressive (model-based method) methods were selected for processing the ICA Doppler signals. The parameters in the autoregressive method were found by using maximum likelihood estimation. The Doppler power spectra of the ICA Doppler signals were obtained by using these spectral analysis techniques. The variations in the shape of the Doppler spectra as a function of time were presented in the form of sonograms in order to obtain medical information. These Doppler spectra and sonograms were then used to compare the applied methods in terms of their frequency resolution and the effects in determination of stenosis and occlusion in the ICA. Reliable information on haemodynamic alterations in the ICA can be obtained by evaluation of these sonograms. [source] Oral hygiene and the need for treatment of the dependent institutionalised elderlyGERODONTOLOGY, Issue 2 2006Sylvie Montal Objective:, To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. Background:, For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. Materials and methods:, From 2003 to 2004, a cross-sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. Results:, The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. Conclusion:, The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly. [source] Asking fathers: a study of psychosocial adaptationHAEMOPHILIA, Issue 5 2004E. K. Herrick Summary., Although few contemporary studies specifically address paternal adaptation, the theme of paternal estrangement from medical care and from family relationships is pervasive in the psychosocial literature on haemophilia. This estrangement has been shown to have a negative effect on fathers' psychological well-being, marital relationships and the adaptive outcome of their sons who have haemophilia. The goals of this study were to provide contemporary data on the psychosocial adaptation of fathers of boys with haemophilia and to examine specific variables that might influence their adjustment. Eighty-three eligible fathers returned a survey instrument that collected demographic and medical information, as well as scores on self-measures of adaptation in marital and parenting roles. Statistically significant direct correlations (P < 0.01) were found between fathers' scores on the Marital Adjustment Test and the Parenting Sense of Competence subscales (parenting efficacy and satisfaction). Variables specific to rearing a son with haemophilia that negatively affected fathers' marital adjustment scores included: feeling left out of medical decision making by their wives or partners, worry about their sons' having limited activity, and the presence of a secondary diagnosis in the affected child. Scores on the parenting efficacy subscale of the PSOC were statistically significantly reduced (i.e. fathers felt less effective in the parenting role) in men who ,rarely' or ,never' infused their sons (42/80, 53%). Variables that negatively affected scores on the parenting satisfaction subscale included frustrating interactions with medical staff and concern about their sons' potential to contract an infection or secondary diagnosis. This paper presents a model to examine the interrelationships among the data and discusses the clinical implications. [source] Psychosocial factors involved in delayed consultation by patients with head and neck cancerHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2005Olivier Rozniatowski DESS Abstract Background. In the north of France, a delay in primary consultation has been noted among patients with head and neck cancer. This group is often correlated with lower socioeconomic status and a lack of medical information. Therefore, the choice to seek consultation is often influenced by symptoms such as pain and change in the size of tumors in the neck. We studied this delay in seeking consultation, focusing on psychosocial variables such as professional and social background, the involvement of a spouse/partner, and the presence of anxiety and depression. Methods. Two rating scales were administered to 50 patients with large tumors (T3/T4) and 50 patients with small tumors (T1/T2), and the results were compared. These rating scales were as follows: (1) a 17-item questionnaire assessing sociodemographic data, presenting symptoms, factors generating the consultation, and reasons for delay; and (2) the Hospital Anxiety and Depression Scale (HADS). Results. Both groups were predominantly male and working-class. Significant differences were observed in time since symptom onset and in conscious delay in seeking medical attention. The group with large tumors was characterized by lower involvement of a spouse/partner, conscious delay before first consultation, greater social isolation, fewer medical visits, and lower HADS anxiety scores. The group with small tumors sought consultation sooner and was characterized by greater involvement of a spouse/partner, correlated with significant anxiety. Depression was not a factor influencing delay within either group. Conclusions. The interpersonal relationship with a spouse/partner seemed to be essential in the dynamics surrounding consultation. Anxiety, rather than socioeconomics status, was a discriminating factor in the delay in seeking consultation. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] The physician,patient relationship: the impact of patient-obtained medical informationHEALTH ECONOMICS, Issue 8 2006Bin Xie Abstract We investigate the impact of patient-obtained medical information (POMI) on the physician,patient relationship when patients, as a group, are heterogeneously informed and a physician's interests do not coincide with those of her patients. Introducing additional well-informed patients to the population discontinuously affects the physician's strategy, having no effect unless a sufficient quantity is added. When few patients are well informed, increasing the precision of their information level has no effect on the physician's strategy. Alternately, when a sufficient number of well-informed patients exists, increasing the precision of their information allows all patients to free-ride by receiving more appropriate treatment recommendations. Counterintuitively, we also identify circumstances under which increasing the general level of information may potentially harm patients. Copyright © 2006 John Wiley & Sons, Ltd. [source] Medical journals and effective dissemination of health researchHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 4 2001Aravinthan Coomarasamy Clinical medical journals have not been effective in meeting the information needs of practitioners and bridging the gap between clinical research and practice. The slow adoption of results of clinical research is at least partly due to the failure of clinical journals to disseminate information in a way that would motivate practitioners to change practice. Although implementation is primarily a local process, medical journals are in a unique position to advance implementation by modifying their focus and adjusting their contents. Strategies that may be useful include publication of pre-appraised evidence summaries and ,clinical bottom-lines' and giving importance to systematic reviews and large evaluative research articles as they represent higher levels of evidence and have greater potential to change practice. Clinical journals should encourage researchers to consider how and by whom the findings will be used and provide information on implications for implementation such as possible strategies that may work, cost-effectiveness, side-effects and potential barriers to implementation. Medical journal publishers should explore ways to cooperate so that findings of landmark clinical trials could be shared thus reducing the ,scatter' of medical information. Electronic media offers numerous advantages such as quick accessibility and linking of information, and medical journals should capitalize on such innovations. There is a paradigm shift in health care practice as evidence is consciously and explicitly incorporated into individual patient care. Medical journals need to change to reflect this change in practice and provide practitioners with valid and relevant information. [source] Predicting developmental deficiencies at the age of four based on data from the first seven months of life,INFANT MENTAL HEALTH JOURNAL, Issue 6 2008Anne Margrethe Rostad The study examines very young children with the aim of identifying precursors of developmental problems during the first 7 months of age. Information from screening and observations in the birth clinic, in the first level of health care, and from parents was collected on five different occasions. The information that was included concerning the child and family was defined as either optimal or nonoptimal. At the age of 4 years, a clinical group was identified (11.1% of the total population). Logistic regression analyses were performed to detect risk factors. Twenty-one precursors were used to create a screening questionnaire that provided useful information (sensitivity = 56.1%, specificity = 98.8%) for predicting developmental problems of the children. The contribution of sociodemographic data was significant; medical information was less significant. The highest prediction rate surprisingly was found in the moderate clinical subgroup (62.1%), compared to the group with more severe problems that had a slightly lower rate (46.7%). The conclusion of the study is that it is possible to detect infants in need of early intervention using a continuous process of observation and screening. [source] Use of the internet and of the NHS direct telephone helpline for medical information by a cognitive function clinic populationINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2003A. J. Larner Abstract Background Internet websites and medical telephone helplines are relatively new and huge resources of medical information (,cybermedicine' and ,telemedicine', respectively) accessible to the general public without prior recourse to a doctor. Study Objectives To measure use of internet websites and of the NHS Direct telephone helpline as sources of medical information by patients and their families and/or carers attending a cognitive function clinic. Design and Setting Consecutive patients seen by one consultant neurologist over a six-month period in the Cognitive Function Clinic at the Walton Centre for Neurology and Neurosurgery, a regional neuroscience centre in Liverpool, UK. Results More than 50% of patients and families/carers had internet access; 27% had accessed relevant information, but none volunteered this. 82% expressed interest in, or willingness to access, websites with relevant medical information if these were suggested by the clinic doctor. Although 61% had heard of the NHS Direct telephone helpline, only 10% of all patients had used this service and few calls related to the reason for attendance at the Cognitive Function Clinic. Conclusions Internet access and use is common in a cognitive function clinic population. Since information from internet websites may shape health beliefs and expectations of patients and families/carers, appropriately or inappropriately, it may be important for the clinic doctor to inquire about these searches. Since most would use websites suggested by the doctor, a readiness to provide addresses for appropriate sites may prove helpful. Copyright © 2003 John Wiley & Sons, Ltd. [source] A conceptual framework and belief-function approach to assessing overall information qualityINTERNATIONAL JOURNAL OF INTELLIGENT SYSTEMS, Issue 1 2003Matthew Bovee We develop an information quality model based on a user-centric view adapted from Financial Accounting Standards Board,1 Wang et al.,2 and Wang and Strong.3 The model consists of four essential attributes (or assertions): accessibility, interpretability, relevance, and integrity. Four subattributes lead to an evaluation of integrity: accuracy, completeness, consistency, and existence. These subattributes relating to integrity are intrinsic in nature and relate to the process of how the information was created and the first three attributes: (accessibility, interpretability, and relevance) are extrinsic in nature. We present our model as an evidential network under the belief-function framework to permit user assessment of quality parameters. Two algorithms for combining assessments into an overall IQ measure are explored, and examples in the domain of medical information are used to illustrate key concepts. We discuss two scenarios, online user and assurance provider, which reflect two likely and important aspects of IQ evaluation currently facing information users,concerns about the impact of poor quality online information and the need for IQ assurance. © 2003 Wiley Periodicals, Inc. [source] Information Therapy: the strategic role of prescribed information in disease self-managementINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2005Molly METTLER Abstract Information Therapy is a new disease management tool that provides cost-effective patient support to a much larger portion of the chronically ill population than is generally reached. Defined as the prescription of specific, evidence-based medical information to a specific patient, caregiver, or consumer at just the right time to help them make a specific health decision or take a self-management action, Information Therapy can be electronically integrated into the process of care. Information prescriptions made available through Information Therapy will support efforts to improve health outcomes and quality in disease management. [source] Development of a clinical chart audit programmeJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2006Y Zissiadis Summary Radiation oncology charts containing medical information and treatment details are the major methods of communication between the various personnel involved in delivering radiation therapy to the patient. It is paramount to good patient care for this communication to be clear, precise and accurate in detail. A regular chart audit should be a part of the quality assurance programme of every radiation oncology department. The primary aim of this study was to develop and assess an objective and quantitative programme for reviewing radiation oncology charts, thereby improving the quality of communication and hence patient management. A secondary aim was to compare the charts of radically treated patients with those treated palliatively. A pilot study using a new chart review tool, developed at the Perth Radiation Oncology Centre, was carried out over an 8-month period. A sample of charts, representing 25% of our treatment group, were assessed using the tool on a monthly basis. A total of 156 charts were reviewed during this time period. Fifty-six per cent were radical treatments and 44% were palliative. The overall mean chart scores significantly improved over the time of this study (P < 0.001). The individual radiation oncologists' scores were also seen to improve during the study period. The alpha coefficients for intra-rater and inter-rater reliability were 0.99 and 0.88, respectively. The chart review programme was found to be an easy-to-use and a reliable tool by both medical and non-medical reviewers. It appeared to have a positive influence on the standard of radiation oncology charts in our department. [source] Analysis of birth-related medical malpractice litigation cases in Japan: Review and discussion towards implementation of a no-fault compensation systemJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2010Nana Uesugi Abstract Aim:, We examined birth-related malpractice civil litigation cases in Japan to clarify the actual status related to the implementation of an obstetrical no-fault compensation system in 2009. Material & Methods:, In this retrospective review, we analyzed legal and medical information from 64 cases with a delivery date after 1987 and a judgment date between April 1997 and March 2007. Results:, The malpractice claim was accepted in 44 cases and rejected in 20 cases. The period from the delivery to the judgment date was lengthy (90.1 months overall). The average amount of damages awarded was ¥97 810 000 for cases of cerebral palsy (CP). Preterm births and less than 2500 g infants represented a higher incidence rate in the rejected cases. There were 32 cases (50.0%) with CP, 18 (28.1%) with infant death, 10 (15.6%) with neonatal death, and 4 (6.3%) with fetal death. Twenty-three of 44 accepted cases (52.3%) and 11/20 rejected cases (55.0%) had a gestational age of more than 33 weeks at birth and weighed more than 2000 g. Forced deliveries were performed in 45/64 cases (70.3%), and augmentation/induction of labor was performed in 28/64 cases (43.8%). There were 13/16 (81.3%) accepted cases that underwent vacuum and/or forceps extraction after labor augmentation/induction. Conclusions:, More than half of our cases could be sufficient for a no-fault compensation system in Japan. Though the system is considered to have some problems that need to be solved, this finding suggests that many children and their families may benefit from the new system without having to file. [source] Use of the Internet by parents of paediatric patientsJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2006Brynn K Wainstein Aim: We aimed to determine the rate of Internet use for obtaining medical information by health-care patients at a tertiary paediatric hospital, whether the Internet may influence patients' attitudes to health-care services and health-care providers and whether patients would prefer the assistance of a professional informatics officer. Methods: An anonymous questionnaire randomly distributed to 450 subjects at Sydney Children's Hospital, Sydney, Australia. Results: A total of 294 (65%) questionnaires were returned. Overall Internet use for medical information was 64% (189/294). Most (97%; 183/189) respondents reported ,wanting to know more' as the reason they sought information on the Internet. Eighty-eight per cent (167/189) of respondents reported that they trust their doctor more than the Internet. Twenty-one per cent (39/189) had presented their doctor with information about which he/she was unaware and 18% (34/189) had altered a health-care decision because of information found on the Internet. The Internet had influenced questions asked of doctors in 83% (156/189). Eighty-six per cent (252/294) of all respondents were in favour of professional assistance to obtain medical information. Conclusion: A large number of patients use the Internet to find information that influences their attitudes to health care. The services of a medical informatics professional would likely benefit both patients and doctors. [source] Demographics and Costs of Colic in Swedish HorsesJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2008A. Egenvall Background: Colic is an important cause of morbidity and mortality in horses. In Sweden, an insurance database with diagnostic medical information is maintained on >30% of the nation's horse population. Hypothesis: The objective was to describe the occurrence of colic, defined by costly veterinary care and life claims, in horses at 1 insurance company during 1997,2002. Horses: All horses (<21 years of age) with complete insurance for veterinary care and life during the period 1997,2002 were included. Methods: Colic was defined as conditions where the main clinical sign was abdominal pain and the problem was related to the gastrointestinal system. The analyses included measures of incidence by sex, breed group, age categories, geographical location (urban/other), survival to and survival after colic, medical cost for colic, and multivariable modeling of risk factors related to the event of colic. Results: In all, 116,288 horses contributed to 341,564 horse years at risk (HYAR). There were 3,100 horses with a colic diagnosis, of which 27% were settled for life insurance. The median gross cost for veterinary care was 4,729 Swedish Kronor (SEK). The overall occurrence and mortality rate of colic was 91 and 24 events per 10,000 HYAR. Survival after colic at 1 month was 76% (95% confidence interval: 75,78%). Conclusions and Clinical Importance: The occurrence of colic varied with breed group, age, and season. The mortality rates probably reflected the true mortality of colic. The veterinary care rates most likely underestimated of the risk colic because they represent relatively costly events. [source] A review of evaluation outcomes of web-based continuing medical educationMEDICAL EDUCATION, Issue 6 2005Vernon R Curran Introduction, The Internet and worldwide web have expanded opportunities for the provision of a flexible, convenient and interactive form of continuing medical education (CME). Larger numbers of doctors are accessing and using the Internet to locate and seek medical information. It has been suggested that a significant proportion of this usage is directly related to questions that arise from patient care. A variety of Internet technologies are being used to provide both asynchronous and synchronous forms of web-based CME. Various models for designing and facilitating web-based CME learning have also been reported. The purpose of this study was to examine the nature and characteristics of the web-based CME evaluative outcomes reported in the peer-reviewed literature. Methods, A search of Medline was undertaken and the level of evaluative outcomes reported was categorised using Kirkpatrick's model for levels of summative evaluation. Results, The results of this analysis revealed that the majority of evaluative research on web-based CME is based on participant satisfaction data. There was limited research demonstrating performance change in clinical practices and there were no studies reported in the literature that demonstrated that web-based CME was effective in influencing patient or health outcomes. Discussion, The findings suggest an important need to examine in greater detail the nature and characteristics of those web-based learning technologies, environments and systems which are most effective in enhancing practice change and ultimately impacting patient and health outcomes. This is particularly important as the Internet grows in popularity as a medium for knowledge transfer. [source] The Utility of Simulation in Medical Education: What Is the Evidence?MOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 4 2009Yasuharu Okuda MD Abstract Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes. Mt Sinai J Med 76:330,343, 2009. © 2008 Mount Sinai School of Medicine [source] Psychological distress in long-term survivors of solid tumors diagnosed in childhood: A report from the childhood cancer survivor studyPEDIATRIC BLOOD & CANCER, Issue 1 2007Brad J. Zebrack PhD Abstract Purpose To evaluate and compare psychological distress in long-term survivors of solid tumors diagnosed in childhood and their siblings, and to identify significant correlates of psychological distress. Procedure Adult survivors (2,778) of solid tumors diagnosed in childhood and 2,925 siblings completed a long-term follow-up questionnaire assessing symptoms associated with depression, somatization, and anxiety, as well as demographic, health, and medical information. Results Overall, a large majority of siblings and survivors reported few, if any, symptoms of psychological distress. In the aggregate, solid tumor cancer survivors reported significantly higher levels of global distress as measured by the Brief Symptom Inventory (BSI-18), as well as higher levels of somatization and anxiety, when compared to siblings. However, when compared to population norms, both survivors and siblings reported lower levels of global and dimensional distress. Female gender, lower educational and income attainment, perceived poor health status and reports of current health problems all were associated with reporting psychological distress symptoms for both survivors and siblings. Among survivors, having a limb amputation was associated with reporting fewer symptoms of global and dimensional distress. Conclusion Poor health status, low levels of income, education, and employment appear to be predictors of distress for survivors of solid tumors. Thus, interventions that promote health and facilitate educational advancement, income attainment and social interaction to minimize isolation and maximize social support may reduce psychological distress and promote quality of life for childhood cancer survivors. Pediatr Blood Cancer 2007;49:47,51. © 2006 Wiley-Liss, Inc. [source] Using medical records to supplement a claims-based comparative effectiveness analysis of antidepressants,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2010Thomas W. Croghan Abstract Purpose Because health insurance claims lack clinical information, comparative effectiveness research studies that rely on these data may be challenging to interpret and may result in biased inference. We conducted an exploratory study to determine if medical information contained in patient charts could offer clinical details that would assist in interpreting the results of a claims-based comparative effectiveness study of selective serotonin reuptake inhibitors (SSRIs). Methods Retrospective review of 457 charts of patients initiating SSRI treatment. Descriptive data elements included patient diagnosis, symptoms of depressive and anxiety disorders, provider's assessment, and medication treatment and side effects. Results Most subjects were excluded from the study because their charts were not accessible (58.7%), they did not have a follow-up visit (55.6%), providers could not be contacted (58.0%), or providers refused participation in the study (36.5%). Among those included in the study, most patients were noted to have depression, but most charts lacked information on the majority of depression symptoms at baseline and follow-up. Few concomitant symptoms, side effects, and other important clinical and treatment characteristics were recorded. Conclusions Inability to obtain charts due to plan or provider refusal, lack of available information in charts at key times in the course of illness, and missing data elements posed considerable challenges and prevented firm conclusions beyond those drawn from the parent, claims-based study. Copyright © 2010 John Wiley & Sons, Ltd. [source] Psychological Illness in Presidents: A Medical Advisory Commission and Disability DeterminationsPOLITICAL PSYCHOLOGY, Issue 1 2006Robert E. Gilbert Although the 25th Amendment is intended to provide for instances of presidential disability, critics claim that it is impractical since it requires vice presidents and cabinet members to move overtly against the president,which they are unlikely to do. Also, they warn that medical information about the president is likely to be concealed. To overcome these problems, they recommend that a Medical Advisory Commission be established at the outset of every presidential administration to examine the president annually and then provide formal medical input so that the vice president and cabinet would be "compelled" to act in the presence of medically determined "inability," whether physiological or psychological. This paper argues, however, that such a proposal is badly flawed and quite unworkable, particularly in the case of psychological illness where accurate diagnosis typically depends on long-term, continuous doctor-patient interaction rather than through sporadic and superficial interchange. It concludes that less draconian measures in implementing the Amendment are far more sensible, such as those proposed by the Working Group on Presidential Disability which are discussed here. [source] Interventions to improve recall of medical information in cancer patients: a systematic review of the literaturePSYCHO-ONCOLOGY, Issue 9 2008Nienke van der Meulen Abstract This systematic review investigates which interventions are effective to improve recall of medical information in cancer patients. A literature research was done in PubMed, PsychINFO, CINAHL and Cochrane Library, following the guidelines of the Cochrane Collaboration. The methodological quality of selected studies was assessed independently by two reviewers. The results were synthesized with a Best Evidence Synthesis. Of initially 5173 found publications, 10 met all selection criteria. The results indicate that an audiotape of the patients' own consultation has added value upon oral information only. However, providing patients with a general audiotape does not improve recall of information and might even inhibit patients' recall. Furthermore, there is scientific evidence, although limited, that the use of a question prompt sheet (QPS) has a positive effect on recall of information, provided that the physician actively endorses this sheet. No evidence was found for an effect of providing patients with a summary letter of the consultation on recall, although research on this subject is scarce. In conclusion, the review suggests that interventions that are tailored to the individual cancer patient, such as an audiotape of the consultation or a QPS, are most effective. Further research needs to be done to establish robust results. Copyright © 2007 John Wiley & Sons, Ltd. [source] Japanese cancer patients' communication style preferences when receiving bad newsPSYCHO-ONCOLOGY, Issue 7 2007Maiko Fujimori Abstract This study describes the communication style preferences of Japanese patients when receiving bad news, examines the factor structure of the measure for patients' preferences (MPP) in a Japanese population, and explores variables that may be associated with patients' communication style preferences. Five hundred twenty-nine cancer outpatients completed several psychosocial measures including the Japanese version of the MPP (MPP-J), the Mental Adjustment to Cancer Scale (MAC), and the Hospital Anxiety and Depression Scale (HADS). The patients desired detailed information and a supportive environment when receiving bad news. The MPP-J demonstrated a 5-factor structure: support, facilitation, medical information, clear explanation, and encouraging question-asking. Regression analyses indicated that a female gender, the fighting spirit and anxious preoccupation dimensions of the MAC were positively associated with all 5 MPP-J factors. In conclusion, Japanese cancer patients' preferences for communication when receiving bad news differ somewhat from those of American patients. Japanese physicians should encourage patients to ask questions and should consider the demographic (e.g. gender), medical (disease status) and psychosocial characteristics (fighting spirit and anxious preoccupation) of patients when delivering bad news. Copyright © 2006 John Wiley & Sons, Ltd. [source] Self-efficacy for coping with cancer: revision of the Cancer Behavior Inventory (version 2.0)PSYCHO-ONCOLOGY, Issue 3 2001Thomas V. Merluzzi The Cancer Behavior Inventory (CBI), a measure of self-efficacy for coping with cancer, was revised by adding a new stress management scale and reducing its length from 43 to 33 items. The 33-item CBI was administered to 280 cancer patients. A principal factors analysis with varimax rotation yielded the hypothesized seven factors (,s in parentheses): (1) maintenance of activity and independence (,=0.86), (2) seeking and understanding medical information (,=0.88), (3) stress management (,=0.86), (4) coping with treatment-related side-effects (,=0.82), (5) accepting cancer/maintaining positive attitude (,=0.86), (6) affective regulation (,=0.81), and (7) seeking support (,=0.80). The , for the entire CBI was 0.94, the test-retest (1 week) reliability coefficient was 0.74, and correlations with measures of quality of life and coping supported its validity. The CBI may be useful to researchers and clinicians and can be integrated into a self-regulation model of coping. Copyright © 2001 John Wiley & Sons, Ltd. [source] Spouse selection by health status and physical traits.AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2010Sardinia Abstract Military medical information and data from civil registers of death and marriage have been used to study the role of physical characteristics and health conditions in explaining access to marriage for the male population of Alghero, a small city located in Sardinia Island (Italy), at the turn of 19th century. Literature data about contemporary populations have already demonstrated the influence of somatic traits in the mate choice. The results presented here show that men with low height and poor health status at the age of 20 were negatively selected for marriage. This holds true also in a society where families often arranged marriages for their children. This pattern of male selection on marriage was found to be particularly marked among the richest and wealthiest SES groups. Our hypothesis is that this social group carefully selected for marriage those individuals who were apparently healthier and therefore more likely to guarantee good health status and better life conditions to offspring. In evolutionary terms, the mate choice component of sexual selection suggests that the height of prospective partners could be claimed as one of the determinants, along with other environmental causes, of the observed higher stature of men belonging to the wealthiest social strata of the Alghero population. Am J Phys Anthropol, 2010. © 2009 Wiley-Liss, Inc. [source] MRI of the Breast: Does the Internet Accurately Report its Beneficial Uses and Limitations?THE BREAST JOURNAL, Issue 2 2009Larissa Nekhlyudov MD Abstract:, As consumer use of the Internet for medical information grows, continuing evaluation of the medical content on the Internet is needed. We evaluated Internet sites describing breast magnetic resonance imaging (MRI), an emerging technology tool in breast cancer diagnosis and screening. We searched Google for sites describing breast MRI and abstracted the affiliation, content, media type, readability, and quality of 90 most popular unique sites. Over half (56%) of the sites were commercially sponsored. The content varied by site and included medical and procedural facts, information about clinical trials, grants and journal articles, as well as human interest stories. Most (82%) sites described potentially beneficial uses of breast MRI, such as further evaluation of newly diagnosed breast cancers (58%); screening women at high risk for breast cancer (54%); evaluation of abnormal breast findings (48%); screening women with dense breasts (48%) or implants (27%); and surveillance for breast cancer recurrences (24%). Approximately half (56%) of the sites described the limitations of breast MRI, most commonly false positive findings (44%) and costs (24%). Website quality, including the display of contact information, sponsorship, currency of information, authorship, and references varied. The reading level was close to high school graduate. Internet sites describing breast MRI were mostly commercially sponsored, more often described the potential beneficial uses of the procedure than its limitations, and were of variable quality and high reading level. With the lack of enforceable standards for display of medical information on the Internet, providers should encourage patients to direct their searches to the most credible sites. [source] Research on Medical Records Without Informed ConsentTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2008Franklin G. Miller Observational research involving access to personally identifiable data in medical records has often been conducted without informed consent, owing to practical barriers to soliciting consent and concerns about selection bias. Nevertheless, medical records research without informed consent appears to conflict with basic ethical norms relating to clinical research and personal privacy. This article analyzes the scope of these norms and provides an ethical justification for research using personally identifiable medical information without consent. [source] The Human Rights Act 1998: implications for anaesthesia and intensive careANAESTHESIA, Issue 9 2002S. M. White Summary The Human Rights Act 1998 was incorporated into UK statutory law on October 2, 2000. The 18 Articles of the Act are likely to have a significant impact on the practice of medicine in the UK, particularly in reference to consent, disclosure of medical information and patient access to healthcare. This article examines the implications of the new legislation for anaesthetic and intensive care practice. [source] | ||||||||||||||||