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Medical Settings (medical + setting)
Selected AbstractsHelping Children Overcome Fear in a Medical Setting: A Guide for Healthcare ProfessionalsACADEMIC EMERGENCY MEDICINE, Issue 3 2010Katren Tyler MD No abstract is available for this article. [source] Psychological trauma exposure and trauma symptoms among individuals with high and low levels of dental anxietyEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 4 2006Ad De Jongh This questionnaire-based study investigated the traumatic background and trauma-related symptomatology among 141 treatment-seeking individuals with high levels of dental anxiety and among a low-anxious reference group consisting of 99 regular dental patients. The highly anxious individuals reported a significantly higher number of traumatic events, both within and outside the dental or medical setting, than those in the reference group (73% vs. 21%). Horrific experiences in the dental setting were the most common traumatic events reported. Of the highly anxious individuals, 46.1% indicated suffering from one or more of the post-traumatic stress disorder (PTSD) symptom clusters (re-experiencing, avoidance, loss of interest, and insomnia), while in the reference group this percentage was 6%. Severity of dental anxiety was significantly associated with number of screening criteria for specific phobia and the extent to which the anxious subjects displayed symptoms of post-traumatic stress. Two variables were uniquely predictive for positive diagnostic screens for dental phobia and PTSD: having experienced a horrific dental treatment and having been a victim of a violent crime. In conclusion, post-traumatic symptoms are common accompaniments of severe forms of dental anxiety and are experienced even when dental treatment is not imminent. [source] A need for a simplified approach to venous thromboembolism prophylaxis in acute medical inpatientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2007D. P. J. Howard Summary Venous thromboembolism (VTE) is a major cause of morbidity and mortality in the UK. Studies have shown that pulmonary embolism causes or contributes to approximately 1 in 10 hospital deaths of medical patients admitted to general hospitals in the UK (Lindblad B, Sternby NH, Bergqvist D. BMJ 1991; 302: 709,11), with pulmonary embolus being the most common preventable cause of hospital death. Thromboprophylaxis is safe, highly effective and cost effective, but despite various current clinical guidelines, physicians fail to prescribe prophylaxis for the majority of medical inpatients at risk of VTE. This article outlines the current evidence for VTE prophylaxis in medical patients and discusses the reasons behind the insufficient use of prophylaxis in the acute medical setting. [source] Lower Cardiac Output Is Associated with Greater White Matter Hyperintensities in Older Adults with Cardiovascular DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007Angela L. Jefferson PhD OBJECTIVES: To preliminarily examine the association between cardiac output, a measure of systemic blood flow, and structural brain magnetic resonance imaging indices of white matter hyperintensities (WMHs). DESIGN: Cross-sectional. SETTING: University medical setting. PARTICIPANTS: Thirty-six older adults without dementia with prevalent cardiovascular disease (aged 56,85). MEASUREMENTS: Cardiac output, WMHs. RESULTS: Partial correlations, adjusting for age and history of hypertension, yielded an inverse relationship between WMHs adjacent to subcortical nuclei and cardiac output (correlation coefficient=,0.48, P=.03); as cardiac output decreased, WMHs increased significantly. No significant associations were found between cardiac output and total WMHs or periventricular WMHs. CONCLUSION: These preliminary data suggest that systemic blood flow, measured according to cardiac output, is inversely associated with WMHs adjacent to the subcortical nuclei. Cerebrovascular degeneration and the chronicity of hypoperfusion may exacerbate the susceptibility of white matter integrity to alterations in blood flow in older adults. [source] Evaluation of the cost-effectiveness of Helicobacter pylori eradication triple therapy vs. conventional therapy for ulcers in JapanALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2001S. Ikeda Background: Helicobacter pylori eradication triple therapy with a combination of lansoprazole, amoxicillin and clarithromycin was approved in Japan in September 2000. Aim: To compare the cost-effectiveness of this eradication therapy with conventional histamine-2 receptor antagonist therapy in Japan. Methods: We established two Markov models for gastric and duodenal ulcers. The model design was based on the Japanese H. pylori eradication guideline and a specialist's opinions, and the model inputs were obtained from a literature review. The models predict the direct medical costs, number of disease-free days and cost per disease-free day for 5 years. Results: In the gastric ulcer model, the expected total costs of eradication and conventional therapies per patient were ¥169 719 and ¥390 921, respectively; the expected numbers of disease-free days were 1454 days and 1313 days, respectively. In the duodenal ulcer model, the expected total costs were ¥134 786 and ¥324 689, respectively; the expected numbers of disease-free days were 1503 days and 1387 days, respectively. The sensitivity analyses showed that the results of the base case analysis were robust. Conclusions: This eradication therapy is less costly and more effective than conventional therapy for the treatment of gastric and duodenal ulcers in a Japanese medical setting. [source] Re-treatment regimens for acute stage of Kawasaki disease patients who failed to respond to initial intravenous immunoglobulin therapy: Analysis from the 17th nationwide surveyPEDIATRICS INTERNATIONAL, Issue 4 2007RITEI UEHARA Abstract Background: Current regimens for re-treatment of patients with Kawasaki disease who failed to respond to the initial intravenous immunoglobulin (IVIG) therapy are still uncertain. The purpose of this study is to reveal what regimens were used as the initial therapy and re-treatment for acute stage of Kawasaki disease in the current Japanese medical setting. Methods: The 17th nationwide survey on Kawasaki disease covered patients whose onset was in 2001 and 2002. In questionnaires sent to all hospitals with a bed capacity of 100 or more and a pediatric department, several questions related to therapeutic regimens for Kawasaki disease were posed. The authors observed the proportions of hospitals that had regimens for patients who failed to respond to the initial therapy. Results: Among those hospitals that responded to the survey, 1052 (64.1%) reported that at least one patient with Kawasaki disease visited the hospital. Among these 1052 hospitals, 73.3% had a regimen to administer 30,39 mg/kg per day of oral aspirin with initial IVIG. The proportion of hospitals that used 1 g/kg per day of IVIG for 2 days was the largest among the options for the initial treatment. For those patients who fail to respond to the initial therapy, 464 hospitals (44.1%) reported that their pediatricians would use additional IVIG only. The number of hospitals that planned to administer high-dose IVIG and ulinastatin was 185 (17.6%). The number of hospitals having regimens of additional IVIG and steroids was 54 (5.1%). Conclusions: The current status of the treatment for patients with Kawasaki disease not responding to the initial IVIG therapy in Japan was revealed. A randomized trial of a large sample is needed to ascertain the effectiveness of several options for re-treating Kawasaki disease. [source] The management of bipolar disorder in primary care: A review of existing and emerging therapiesPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2005MICHAEL BERK mbbch, ff (psych), franzcp, mmed (psych) Abstract, Recent evidence suggests that the prevalence of bipolar disorder is as much as fivefold higher than previously believed, and may amount to nearly 5% of the population, making it almost as common as unipolar major depression. It is, therefore, not unrealistic to assume that primary care or family physicians will frequently encounter bipolar patients in their practice. Such patients may present with a depressive episode, for a variety of medical reasons, for longer-term maintenance after stabilization, and even with an acute manic episode. Whatever the reason, a working knowledge of current trends in the acute and longer-term management of bipolar disorder would be helpful to the primary care physician. In addition, an understanding of important side-effects and drug interactions that occur with drugs used to treat bipolar disorder, which may be encountered in the medical setting, are paramount. This paper will attempt to review existing and emerging therapies in bipolar disorder, as well as their common drug interactions and side-effects. [source] Genetic admixture, self-reported ethnicity, self-estimated admixture, and skin pigmentation among Hispanics and Native AmericansAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 4 2009Yann C. Klimentidis Abstract The relationship between ethnicity and biology is of interest to anthropologists, biomedical scientists, and historians in understanding how human groups are constructed. Ethnic self-identification in recently admixed groups such as Hispanics, African Americans, and Native Americans (NA) is likely to be complex due to the heterogeneity in individual admixture proportions and social environments within these groups. This study examines the relationships between self-identified ethnicity, self-estimated admixture proportions, skin pigmentation, and genetic marker estimated admixture proportions. These measures were assessed using questionnaires, skin color measurements, and genotyping of a panel of 76 ancestry informative markers, among 170 Hispanics and NAs from New Mexico, a state known for its complex history of interactions between people of NA and European (EU) ancestry. Results reveal that NAs underestimate their degree of EU admixture, and that Hispanics underestimate their degree of NA admixture. Within Hispanics, genetic-marker estimated admixture is better predicted by forehead skin pigmentation than by self-estimated admixture. We also find that Hispanic individuals self-identified as "half-White, half Hispanic" and "Spanish" have lower levels of NA admixture than those self-identified as "Mexican" and "Mexican American." Such results highlight the interplay between culture and biology in how individuals identify and view themselves, and have implications for how ethnicity and disease risk are assessed in a medical setting. Am J Phys Anthropol, 2009. © 2008 Wiley-Liss, Inc. [source] A Preliminary Report of Knowledge Translation: Lessons From Taking Screening and Brief Intervention Techniques From the Research Setting Into Regional Systems of CareACADEMIC EMERGENCY MEDICINE, Issue 11 2009Edward Bernstein MD Abstract This article describes a limited statewide dissemination of an evidence-based technology, screening, brief intervention, and referral to treatment (SBIRT), and evaluation of the effects on emergency department (ED) systems of care, utilizing the knowledge translation framework of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), using both quantitative and qualitative data sources. Screening and brief intervention (SBI) can detect high-risk and dependent alcohol and drug use in the medical setting, provide early intervention, facilitate access to specialty treatment when appropriate, and improve quality of care. Several meta-analyses demonstrate its effectiveness in primary care, and the federal government has developed a well-funded campaign to promote physician training and adoption of SBI. In the busy environment of the ED, with its competing priorities, researchers have tested a collaborative approach that relies on peer educators, with substance abuse treatment experience and broad community contact, as physician extenders. The ED-SBIRT model of care reflects clinician staff time constraints and resource limitations and is designed for the high rates of prevalence and increased acuity typical of ED patients. This report tracks services provided during dissemination of the ED-SBIRT extender model to seven EDs across a northeastern state, in urban, suburban, and rural community settings. Twelve health promotion advocates (HPAs) were hired, trained, and integrated into seven ED teams. Over an 18-month start-up period, HPAs screened 15,383 patients; of those, 4,899 were positive for high risk or dependent drinking and/or drug use. Among the positive screens, 4,035 (82%) received a brief intervention, and 57% of all positives were referred to the substance abuse treatment system and other community resources. Standardized, confidential interviews were conducted by two interviewers external to the program with 24 informants, including HPAs and their supervisors, clinicians, nurse managers, and ED directors across five sites. A detailed semistructured format was followed, and results were coded for thematic material. Barriers, challenges, and successes are described in the respondents' own words to convey their experience of this demonstration of SBIRT knowledge translation. Five of seven sites were sustained through the second year of the program, despite cutbacks in state funding. The dissemination process provided a number of important lessons for a large rollout. Successful implementation of the ED-SBIRT HPA model depends on 1) external funding for start-up; 2) local ED staff acting as champions to support the HPA role, resolve territorial issues, and promote a cultural shift in the ED treatment of drug and alcohol misuse from "treat and street" to prevention, based on a knowledge of the science of addiction; 3) sustainability planning from the beginning involving administrators, the billing and information technology departments, medical records coders, community service providers, and government agencies; and 4) creation and maintenance of a robust referral network to facilitate patient acceptance and access to substance abuse services. [source] Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical settingCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 5 2007Richard Reading Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting . StirlingJ. & the Committee on Child Abuse and Neglect ( 2007 ) Pediatrics , 119 , 1026 , 30 . DOI: 10.1542/peds.2007,0563. [source] Health, Healthcare Utilization, and Satisfaction with Service: Barriers and Facilitators for Older Korean AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2005Yuri Jang PhD The present study assessed predictive models of subjective perception of health, healthcare utilization (hospital visits), and satisfaction with healthcare service using a sample of 230 older Korean Americans. Predisposing characteristics (age, sex, and education), health needs (chronic conditions, functional disability, and number of sick days), and a variety of enabling factors (health insurance, English speaking ability, transportation, living arrangement, trust in Western medicine, and reported experience of disrespect in medical settings) were considered. After controlling for predisposing and need factors, health insurance coverage was found to be a significant enabling factor for hospital visits. Subjective perception of health was found to be significant not only for healthcare utilization, but also for satisfaction with service. A greater likelihood of satisfaction was also observed in individuals with health insurance, better English-speaking ability, and greater trust in Western medical care. The reported experience of disrespect or discrimination in medical settings significantly reduced the odds of satisfaction with service. [source] Identifying and screening for psychological and comorbid medical and psychological disorders in medical settings,JOURNAL OF CLINICAL PSYCHOLOGY, Issue 3 2009Rodger Kessler Abstract There is increased attention to the medical and economic consequences of psychological problems comorbid with medical issues. There is also a clear awareness that most psychological problems are assessed and responded to in nonpsychiatric medical settings. This has furthered interest and attention in implementing screening procedures to better identify psychological, behavioral, and substance abuse problems in medical settings. Such interest is taking the form of recommendations from federal government task forces, and the funding of large projects to include screening in medical settings. At the same time there has been further attention to brief, valid, and reliable measures with which to capture psychological comorbidities. However, there have been multiple concerns raised about a variety of issues concerning the utility and effectiveness of such screening procedures and the identification of multiple issues to be considered in screening design. The author outlines and reviews the rationale and concerns about screening, identifies the issues that need to be considered in screening program development, and describes the efforts to develop a screening capacity in a rural family practice. © 2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:1,15, 2009. [source] Rationality in medical decision making: a review of the literature on doctors' decision-making biasesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2001Brian H. Bornstein Abstract The objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision-making literatures. A number of biases can affect the ways in which doctors gather and use evidence in making diagnoses. Biases also exist in how doctors make treatment decisions once a definitive diagnosis has been made. These biases are not peculiar to the medical domain but, rather, are manifestations of suboptimal reasoning to which people are susceptible in general. None the less, they can have potentially grave consequences in medical settings, such as erroneous diagnosis or patient mismanagement. No surefire methods exist for eliminating biases in medical decision making, but there is some evidence that the adoption of an evidence-based medicine approach or the incorporation of formal decision analytic tools can improve the quality of doctors' reasoning. Doctors' reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but there are positive signs that means for alleviating some of these biases are available. [source] Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients: Design and ImplementationALCOHOLISM, Issue 2 2010Shelly F. Greenfield Background:, While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder. Methods:, We designed and implemented a randomized controlled trial (RCT) to determine the effectiveness of integrating pharmacotherapy and behavioral treatments for AUDs into routine medical care for TB in the Tomsk Oblast Tuberculosis Service (TOTBS) in Tomsk, Russia. Eligible patients are diagnosed with alcohol abuse or dependence, are newly diagnosed with TB, and initiating treatment in the TOTBS with Directly Observed Therapy-Short Course (DOTS) for TB. Utilizing a factorial design, the Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients (IMPACT) study randomizes eligible patients who sign informed consent into 1 of 4 study arms: (1) Oral Naltrexone + Brief Behavioral Compliance Enhancement Therapy (BBCET) + treatment as usual (TAU), (2) Brief Counseling Intervention (BCI) + TAU, (3) Naltrexone + BBCET + BCI + TAU, or (4) TAU alone. Results:, Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors. Conclusions:, The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care settings. [source] The Challenge of Cross-Cultural Clinical Trials Research: Case Report from the Tibetan Autonomous Region, People's Republic of ChinaMEDICAL ANTHROPOLOGY QUARTERLY, Issue 3 2005VINCANNE ADAMS Efforts to conduct Western clinical research in non-Western medical settings with little or no familiarity with such methodologies are on the rise, but documented accounts of the ways that biomedical science requires negotiation and translation across cultures are not plentiful. This article adds to this literature through analysis of an NICHD-funded collaborative research effort in women's health carried out in the Tibetan Autonomous Region of the People's Republic of China. The research involved a feasibility study for an eventual clinical trial comparing Tibetan medicine with misoprostol for preventing postpartum hemorrhage in delivering women. It explores strategies of negotiation and translation in and around notions of the scientific method, informed consent procedures, randomization, blinding, placebo, and concepts of medical standardization. [source] Motivational interviewing for adherence problems in cystic fibrosisPEDIATRIC PULMONOLOGY, Issue 3 2010Alistair J.A. Duff Abstract This review focuses on adherence in cystic fibrosis (CF), and the factors known to influence it. In particular, it discusses the importance of effective communication in clinical settings and considers the evidence for the effectiveness of motivational interviewing (MI), to increase adaptation and adherence in physical health and CF. The review also contains an overview of the key concepts of MI, its' practice in medical settings and recommendations on how to adopt MI techniques in the routine care of people with CF. Pediatr Pulmonol. 2010; 45:211,220. © 2010 Wiley-Liss, Inc. [source] Discrepant Feeling Rules and Unscripted Emotion Work: Women Coping With Termination for Fetal AnomalyAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 4 2009Judith L. M. McCoyd PhD The sociology of emotion is rapidly evolving and has implications for medical settings. Advancing medical technologies create new contexts for decision-making and emotional reaction that are framed by "feeling rules." Feeling rules guide not only behavior, but also how one believes one should feel, thereby causing one to attempt to bring one's authentic feelings into line with perceived feeling rules. Using qualitative data, the theoretical existence of feeling rules in pregnancy and prenatal testing is confirmed. Further examination extends this analysis: at times of technological development feeling rules are often discrepant, leaving patients with unscripted emotion work. Data from a study of women who interrupted anomalous pregnancies indicate that feeling rules are unclear when competing feeling rules are operating during times of societal and technological change. Because much of this occurs below the level of consciousness, medical and psychological services providers need to be aware of potential discrepancies in feeling rules and assist patients in identifying the salient feeling rules. Patients' struggles ease when they can recognize the discrepancies and assess their implications for decision-making and emotional response. [source] Atypical antipsychotics in the treatment of deliriumPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2009Vaios Peritogiannis md Delirium is common in all medical settings. Atypical antipsychotics are increasingly used for the management of delirium symptomatology but their effectiveness has not been systematically studied. The aim of the present study was therefore to provide an up-to-date review on the use of atypical antipsychotics in the treatment of delirium. A search was conducted of the databases of MEDLINE, PsycINFO and EMBASE from 1997 to 2008 for English-language articles using the key words ,delirium' and the names of all the atypical antipsychotics. A total of 23 studies were used for this review. Fifteen of the studies were single-agent trials. Four studies were comparison trials, including one double-blind trial, and four studies were retrospective, including three comparison studies. All studies reported improvement of delirium symptomatology after the administration of atypical antipsychotics. No study included a placebo group. Other limitations included sample heterogeneity, small sample size, different rating scales for delirium, and lack of adequate controls. The improvement in delirium was observed within a few days after treatment initiation and the doses given were relatively low. Atypical antipsychotics were well tolerated, but safety was not evaluated systematically. Atypical antipsychotics appear to be effective and safe in symptomatic treatment of delirium but the evidence is limited and inconclusive. There are no double-blind, placebo-controlled studies assessing the efficacy and safety of these agents in delirium. Further research is needed with well-designed studies. [source] Assessment of psychiatric patients' competency to give informed consent: Legal safeguard of civil right to autonomous decision-makingPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2000Toshinori Kitamura FRCPSYCH Abstract Amendment of the Mental Health and Welfare Law in Japan will limit admission for medical care and protection only for those individuals who are incapable of giving consent to admission. This is a first in the history of the Japanese mental health legislation. By reviewing the law and psychiatric literature, it is argued that: (i) informed consent is a legal transaction that embodies the idea of an individual's right to autonomous decision-making in medical settings; (ii) health professionals have a duty to protect those individuals who cannot decide medical matters because of lack of capacity to do so; (iii) some patients are marginally incompetent so assessment of their competency is essential in protecting patients' civil rights; (iv) in order for a competency assessment to be reliable (and hence fair) the method should be psychometrically sound; (v) at the same time, in order for a competency assessment to be valid, the structure of a competency assessment should match the patient's psychological, cultural, and social background; and (vi) because informed consent is a process rather than a cross-sectional event, a competency assessment should be performed in everyday practice. The use of a brief and semistructured interview to assess patients' competency to give informed consent may meet all of the requirements described. [source] Trouble in the village?PSYCHOTHERAPY AND POLITICS INTERNATIONAL, Issue 2 2004Counselling, clinical psychology in the NHS Abstract Over the past two decades, counselling has sought to position itself within a number of different professional contexts. In recent years the growth of counselling in medical settings, most notably in primary care, has been considerable, and in many areas in the UK the presence of a counsellor in a GP surgery is now the norm rather than the exception. In many cases, counsellors are employed by psychological services and are supervised by psychologists. This is often an uneasy relationship and raises a number of issues that are highlighted in this paper. Copyright © 2004 Whurr Publishers Ltd. [source] Practitioner Review: Clinical applications of pediatric hypnosisTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 8 2007Jeffrey I. Gold Background:, Over the past quarter century, hypnosis has been employed in a broad range of pediatric clinical settings; however, its efficacy and feasibility as a treatment approach for children and adolescents remain in question. Method:, Published studies on the role of clinical hypnosis in the management of specific pediatric medical and psychological conditions were identified and reviewed. Results:, Pediatric clinical hypnosis has been employed in diverse medical settings to treat primary conditions (e.g., enuresis), as well as to address factors related to management of the condition (e.g., skills training for asthma) or its treatment (e.g., burn dressing changes). Despite great breadth to the possible applications of pediatric hypnosis and many reported successes, much of the present research comprises case histories and small, uncontrolled group studies. Conclusion:, To date, research in pediatrics views clinical hypnosis as a promising tool with the potential to help manage a variety of conditions. However, additional research, particularly utilizing randomized, controlled methodologies and adequate sample sizes, is required. [source] Evaluation of Patients with Palpitations: Cardiac Event Recorder Versus 48-hour Holter MonitoringANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2000Ewa Makowska M.D. Objectives: (1) To compare a diagnostic yield of cardiac event recorders with that of 48-hour Holler monitoring, (2) to determine the etiologies of palpitations, and (3) to assess an optimal duration of using an event recorder by a patient. Background: Palpitation is a common symptom which accounts for 16% of total complaints reported by patients in general medical settings. An ambulatory Holter ECG monitoring or an event recorder can be used to establish the cause of palpitations. Methods: (1)The study group consisted of 33 consecutive patients (24 females, 9 males, mean age 50 ± 32 years) with undiagnosed attacks of palpitations, occurring at least once per month. Each patient was randomly allocated to use either an event monitor or 48-hour Holler monitoring. The patient kept the event monitor for 4 weeks. After the first monitor was returned, the patient was given the other device. Results: Holter monitoring determined the etiology of palpitations in 11 (33%) patients, and the event recorder in 21 (64%) patients (P = 0.0138). In the whole study group, the etiology of palpitations was disclosed in 23 (70%) patients. The diagnosis was possible using Holler ECG monitoring in only 2 (9%) patients, whereas the event recorder revealed the underlying mechanism of palpitations in 12 (52%) patients (P = 0.0007). In nine (39%) patients both methods were able to disclose the eliology of palpitations. The findings of 117 recordings obtained using an event recorder during palpitations were atrial fibrillation in 10 (9%), narrow QRS tachycardia in 4 (3%), frequent supraventricular eclopy in 17 (15%), frequent ventricular eclopy in 6 (5%), and episodes of palpitations sinus rhythm were recorded in the remaining 80 (68%). Of patients who experienced episodes of palpitations while using an event recorder, the earliest recording was obtained on the first day of the study, and the latest on the 18 day of using the event recorder. Conclusions: (1) The cardiac event recorders yield more diagnoses than 48-hour Holter monitoring in patients with palpitations occurring at least once per month, (2) in this group of patients the event recorder provided a diagnostic ECG recording during the first 18 days of using the device, and (3) in the majority (57%) of patients a normal sinus rhythm was recorded during episodes of palpitations. A.N.E. 2000;5(4):315,321 [source] Emergency Medical Practice: Advancing Cultural Competence and Reducing Health Care DisparitiesACADEMIC EMERGENCY MEDICINE, Issue 1 2009Aasim I. Padela MD Abstract In an increasingly diverse patient population, language differences, socioeconomic circumstances, religious values, and cultural practices may present barriers to the delivery of quality care. These obstacles contribute to the health care disparities observed in all areas of medical care. Increasing cultural competence has been cited as part of the solution to reduce disparities. The emergency department (ED) is an environment where cultural sensitivity is particularly needed, as it is often a primary source of health care for the underserved and ethnic and racial minorities and a place where high patient volume and acuity place the provider under demanding time pressures, yet the emergency medicine (EM) literature on health care disparities and cultural competence is limited. The authors present three clinical scenarios highlighting challenges in providing equitable emergency care to minority populations. Using these cases as illustrations, three processes are proposed that may improve the quality of care delivered to minority populations: 1) increase cultural awareness and reduce provider biases, enabling providers to interact more effectively with different patient populations; 2) accommodate patient preferences and needs in medical settings through practice adjustments and cultural modifications; and 3) increase provider diversity to raise levels of tolerance, awareness, and understanding for other cultures and create more racially and/or ethnically concordant patient,physician relationships. [source] Is Consent "Informed" When Patients Receive Care from Medical Trainees?ACADEMIC EMERGENCY MEDICINE, Issue 12 2008Daniel J. Pallin MD Abstract Objectives:, Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of "informed" on "consent," by assessing willingness to be seen by trainees before and after information about trainee's credentials. Methods:, A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar's test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information. Results:, The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of "medical student," and 35%"intern" and "resident." In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower-ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029). Conclusions:, Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees' credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non,English speakers and should address these issues in other medical settings. [source] Decision making about pre-medication to childrenCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 6 2008M. Proczkowska-Björklund Abstract Background Inviting the child to participate in medical decisions regarding common medical procedures might influence the child's behaviour during the procedures. We wanted to study nurse decision-making communication regarding pre-medication before ear, nose and throat (ENT) surgery. Method In total, 102 children (3,6 years) signed for ENT surgery were video-filmed during the pre-medication process. The nurse decision-making communication was identified, transcribed and grouped in six main categories dependent on the level of participation (self-determination, compromise, negotiation, questioning, information, lack of communication). Associations between child factors (age, gender, verbal communication and non-verbal communication) and different nurse decision-making communication were studied. Associations between the decision-making communication and verbal hesitation and/or the child's compliance in taking pre-medication were also studied. Results Totally, information was the most frequently used category of decision making communication followed by negotiation and questioning. To the children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more compromise, negotiation and gave less information to children with less compliance. No specific type of nurse decision-making communication was associated with verbal hesitation. The most important predictors for verbal hesitation were none or hesitant eye contact with nurse (OR = 4.5) and placement nearby or in parent's lap (OR = 4.7). Predictors for less compliance in taking pre-medication were verbal hesitation from the child (OR = 22.7) and children who did not give any verbal answer to nurse initial questions (OR = 5.5). Conclusion Decision-making communication could not predict the child's compliance during pre-medication. Although negotiation, questioning and self-determination communication were associated with more unwillingness to take pre-medication. More knowledge is needed about communication to children in medical settings and how it influences the child's behaviours. [source] Prevalence of recurrent complaints of pain among Greek schoolchildren and associated factors: A population-based studyACTA PAEDIATRICA, Issue 8 2006Chryssa Bakoula Abstract Aim: To determine the prevalence of recurrent complaints of pain (RCP) in Greek children, and to examine associations with socio-demographic characteristics and psychosocial factors. Methods: Cross-sectional study comprising a nationally representative population of 8130 7-y-old Greek schoolchildren. Data were collected by mailed questionnaires (response rate 89%). RCP was defined as present if at least one of the complaints of headache, abdominal pain or limb pain occurred at least once a week. Results: The RCP prevalence rate was 7.2%, with significant gender differences (8.8% of girls, 5.7% of boys; p<0.001). RCP was significantly positively associated with a chronic health problem among the children, frequent change of residence, poor school performance, often watching TV and rarely playing with other children. There were no statistically significant associations of RCP with family structure and socio-economic status. Conclusion: The results are indicative of the prevalence of RCP in Greek schoolchildren. This study enlightens the psychosocial component of RCP and emphasizes the importance of gathering information on children's social background in medical settings. [source] | ||||||||||||||||