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Medical Visits (medical + visit)

Distribution by Scientific Domains

Medical Sciences	83%

Selected Abstracts

Medical visits among adults with symptoms commonly associated with an overactive bladder

BJU INTERNATIONAL, Issue 3 2006
SUNNY H. KIM
OBJECTIVES To examine nationally representative data and thus obtain estimates of the use of healthcare providers associated with the overactive bladder (OAB) symptoms, a condition characterized by frequency, urgency and nocturia, with or with no urge incontinence, as although it is ranked among the 10 most common chronic medical conditions in the USA, the level of OAB-associated medical treatment remains largely unknown. METHODS To estimate the number of annual OAB-associated medical visits among patients aged ,18 years, three national databases in the USA (year 2000) were examined: the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey. Population estimates were constructed using design-based statistical analyses to account for the complex survey designs of data. RESULTS During 2000, adult Americans made 1.4 million (95% confidence interval 1.1,1.8 million) ambulatory visits to non-Federal office-based physicians with International Classification of Disease (ICD-9) coding indicative of OAB symptoms. Accounting for emergency and outpatient department visits, as well as non-Federal short-stay hospital discharges, the estimated number of medical visits with OAB-associated ICD-9 coding was <1.5 million. CONCLUSION The prevalence of OAB was estimated to be 34 million adult Americans. When 1.4 million ambulatory visits were compared with this prevalence, as few as 4% of adult Americans with OAB sought medical treatment during the year 2000. The present results therefore suggest a large unmet medical need among the population of adult Americans with OAB. [source]

The medical visit context of treatment decision-making and the therapeutic relationship

HEALTH EXPECTATIONS, Issue 1 2000
Debra Roter Dr (Phil)
The ascendance of the autonomy paradigm in treatment decision-making has evolved over the past several decades to the point where few bioethicists would question that it is the guiding value driving health-care provider behaviour. In achieving quasi-legal status, decision-making has come to be regarded as a formality largely removed from the broader context of medical communication and the therapeutic relationship within which care is delivered. Moreover, disregard for individual patient preference, resistance, reluctance, or incompetence has at times produced pro forma and useless autonomy rituals. Failures of this kind, have been largely attributed to the psychological dynamics of the patients, physicians, illnesses, and contexts that characterize the medical decision. There has been little attempt to provide a framework for accommodating or understanding the larger social context and social influences that contribute to this variation. Applying Paulo Freire's participatory social orientation model to the context of the medical visit suggests a framework for viewing the impact of physicians' communication behaviours on patients' capacity for treatment decision-making. Physicians' use of communication strategies can act to reinforce an experience of patient dependence or self-reliance in regard to the patient-physician relationship generally and treatment decision-making, in particular. Certain communications enhance patient participation in the medical visit's dialogue, contribute to patient engagement in problem posing and problem-solving, and finally, facilitate patient confidence and competence to undertake autonomous action. The purpose of this essay is to place treatment decision-making within the broader context of the therapeutic relationship, and to describe ways in which routine medical visit communication can accommodate individual patient preferences and help develop and further patient capacity for autonomous decision-making. [source]

Reliability and Validity of the Alcohol Use Disorders Identification Test (AUDIT) Imbedded Within a General Health Risk Screening Questionnaire: Results of a Survey in 332 Primary Care Patients

ALCOHOLISM, Issue 5 2000
Jean-Bernard Daeppen
Background: Self-administered, general health risk screening questionnaires that are administered while patients wait in the doctor's office may be a reasonable and timesaving approach to address the requirements of preventive medicine in a typical 10-min medical visit. The psychometric characteristics of the Alcohol Use Disorders Identification Test (AUDIT) incorporated within a health questionnaire (H-AUDIT) have not been examined. Methods: The reliability and validity of the self-administered AUDIT were compared between the H-AUDIT and the AUDIT used as a single scale (S-AUDIT) in 332 primary care patients. Results: No major demographic or alcohol use characteristics were found between the 166 subjects who completed the H-AUDIT and the 166 individuals who completed the S-AUDIT. The test-retest reliability of the 166 subjects who completed the H-AUDIT [estimated by Spearman correlation coefficient at a 6-week interval (0.88), internal consistency (total correlation coefficients for all items ranged from 0.38 to 0.69; Cronbach , index 0.85), and the sensitivity and specificity of the H-AUDIT were used to identify at-risk drinkers' areas under receiver operating characteristic (0.77) and alcohol-dependent subjects' areas under receiver operating characteristic (0.89)] was similar to the same measurements obtained with the 166 individuals who completed the S-AUDIT. Conclusions: The AUDIT incorporated in a health risk screening questionnaire is a reliable and valid self-administered instrument to identify at-risk drinkers and alcohol-dependent individuals in primary care settings. [source]

Psychosocial factors involved in delayed consultation by patients with head and neck cancer

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2005
Olivier 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]

Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2003
Kurt Kroenke MD
Abstract Somatic symptoms are the leading cause of outpatient medical visits and also the predominant reason why patients with common mental disorders such as depression and anxiety initially present in primary care. At least 33% of somatic symptoms are medically unexplained, and these symptoms are chronic or recurrent in 20% to 25% of patients. Unexplained or multiple somatic symptoms are strongly associated with coexisting depressive and anxiety disorders. Other predictors of psychiatric co-morbidity include recent stress, lower self-rated health and higher somatic symptom severity, as well as high healthcare utilization, difficult patient encounters as perceived by the physician, and chronic medical disorders. Antidepressants and cognitive-behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache. A stepped care approach is described, which consists of three phases that may be useful in the care of patients with somatic symptoms. Copyright © 2003 Whurr Publishers Ltd. [source]

When Will Older Patients Follow Doctors' Recommendations?

JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 5 2008
Interpersonal Treatment, Outcome Favorability, Perceived Age Differences
Study participants were 104 older patients (M age = 76 years) who rated their last visit to a doctor. If they felt respectfully and honestly treated by the doctor, they were more willing to confide in a medical professional. If they received the information that they needed, they were more likely to follow the doctor's recommendations. However, if they perceived their doctor to be closer to them in age, respectful treatment was most closely related to compliance. If they perceived their doctor to be much younger than themselves, obtaining needed information was related most closely to compliance. The results illustrate the value of treating age as a salient social category that can shape older patients' reactions to their medical visits. [source]

Influence exerted on drug prescribing by patients' attitudes and expectations and by doctors' perception of such expectations: a cohort and nested case-control study

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2008
Eugenia Lado BS
Abstract Rationale, aims and objectives, Although demand for medication is regarded as one of the most important factors in pharmaceutical expenditure, little is known about patients' influence on drug prescribing. This study assesses the influence exerted on drug prescribing by patients' attitudes and expectations, and by doctors' perception of such expectations. Method, We conducted a population-based cohort study covering 937 subjects attending a health centre in the northwest of Spain. Prescription-drug advertising directly targeted at patients is banned in Spain. We conducted home-based interviews at the start of follow-up to assess patients' attitudes, and monthly telephone interviews during the 1-year follow-up period to assess consumption of medical drugs and medical visits. Using nested case-control study covering 127 of the cohort subjects who attended the health centre, we assessed patients' pre-consultation expectations for prescriptions, doctors' perception of such patients' expectations, and the drugs actually prescribed. Results, Of the total sample, 69.3% answered the home-based questionnaire, 77.6% completed 11 or more months of follow-up, and 100% of cohort subjects who attended the health centre responded to the pre-consultation survey conducted in the waiting room. Patients' attitudes, though not associated with prescription (P > 0.1), were, however, associated with demand for medical consultation (P < 0.01), self-medication (P < 0.01) and prescription expectations (P < 0.01). Although doctors' perception of patients' expectations did indeed show an association with drug prescribing (P = 0.001), there was no association between patients' expectations and doctors' perception of such expectations (P > 0.1), as these tended to be overestimated by doctors. Conclusion, We conclude that, although doctors prescribe in accordance with what they believe their patients expect, in practice patients exert no influence on drug prescribing because their prescription expectations are misconstrued by doctors, who overestimate them. [source]

Impact of human metapneumovirus in childhood: Comparison with respiratory syncytial virus and influenza viruses,

JOURNAL OF MEDICAL VIROLOGY, Issue 1 2005
Samantha Bosis
Abstract This study evaluated the overall impact of human metapneumovirus (hMPV) infection in 1,505 children and their households, and compared it with infections due to respiratory syncytial virus (RSV) and influenza viruses. Nasopharyngeal swabs were used at enrollment to collect specimens for the detection of hMPV, RSV, and influenza virus RNA by reverse-transcriptase polymerase chain reaction (RT-PCR). hMPV was detected in 42 children (2.8%), RSV in 143 (9.5%; P,<,0.0001 vs. hMPV), and influenza viruses in 230 (15.3%; P,<,0.0001 vs. hMPV). Of the 42 hMPV-positive samples, one was also positive for RSV and six for influenza viruses, for a co-infection rate of 16.7%. Clinically, hMPV was identified only in patients with acute respiratory infection, whereas RSV and influenza viruses were also detected in patients with different clinical manifestations. Symptoms with statistically significant different proportions at presentation were fever (more frequent in the hMPV- and influenza-positive children) and wheezing with bronchiolitis or asthma exacerbation (more frequent among hMPV- and RSV-positive cases). The households of the hMPV- and the influenza-positive children had significantly more illnesses, needed significantly more medical visits, received more antipyretics, and missed significantly more work or school days than those of the RSV-positive children. Results show that hMPV is an emerging cause of acute respiratory infection in childhood, and may have a significant clinical and socioeconomic impact on children and their families. J. Med. Virol. 75:101,104, 2005. © 2005 Wiley-Liss, Inc. [source]

A single versus multiple doses of dexamethasone in infants wheezing for the first time

PEDIATRIC PULMONOLOGY, Issue 9 2008
Suzanne Schuh MD
Abstract Rationale: Corticosteroid therapy is not routinely recommended in true bronchiolitis. However, since bronchiolitis and the first asthma attack are impossible to distinguish, some infants with the first wheezing episode receive corticosteroids. Optimal duration of corticosteroid therapy in this scenario is unknown. This study compared efficacy of multiple administrations and a single dose of dexamethasone in bronchiolitis. Methods: In this randomized double blind trial, previously healthy outpatients 2,23 months of age with bronchiolitis and Respiratory Disease Assessment Instrument (RDAI) score 6 or more received 1 mg/kg of oral dexamethasone in the Emergency Department. Prior to discharge at 4 hr they were randomized to either 4 daily doses of dexamethasone 0.15 mg/kg or placebo equivalent. Primary outcome was the proportion of subsequent hospitalizations or prescribed trials of bronchodilator/corticosteroid therapy for dyspnea by day 6 in the groups. Secondary outcomes were changes in the RDAI to day 6, and proportions with unscheduled visits by days 6 and 28. Results: The rate of primary outcome in the single dose group (SDG, N,=,64) was 9/64 or 14.1% versus 7/61 or 11.5% in the multiple dose group (MDG, N,=,61) [95% CI 0.09; 0.14]. Twelve (18.8%) children in the SDG had unscheduled medical visits by day 6 versus 11 (18.0%) children in the MDG [95% CI 0.13; 0.14]. On day 6 the RDAI decreased from 9.5,±,2.1 to 2.1,±,2.4 in the SDG and from 9.8,±,2.2 to 1.6,±,2.3 in the MDG [95% CI 0.36; 2.06]. Between days 7,28, 24/64 (37.5%) SDG infants returned for care versus 20/61 (32.8%) of the MDG [95% CI 0.12; 0.21]. Conclusions: Our study suggests that, in outpatients with bronchiolitis who receive dexamethasone, continuation of this agent beyond the initial dose does not provide significant benefit. Pediatr Pulmonol. 2008; 43:844,850. © 2008 Wiley-Liss, Inc. [source]

Patterns of medication use in the immigrant population resident in Spain: associated factors

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2009
P. Carrasco-Garrido PhD
Abstract Purpose This study mainly aimed at to ascertain to ascertain the prevalence of the consumption of medications, prescribed and self-medicated, among the immigrant population (economic immigrants and not economic immigrants) resident in Spain, and to identify the factors associated with such consumption in this population. Methods We have worked with individualized secondary data, collected in the Spanish National Health Survey carried out in 2006 and 2007 (SNHS-06), from the Ministry of Health and Consumer Affairs. A total of 2055 subjects born outside Spain, aged 16 years or over, were analysed. The independent variables were sociodemographic and health-related, and the dependent variable was medication use. Using logistic multivariate regression models we have estimated the independent effect of each of these variables on the medication consumption. Results The 55.8% of immigrant population responded affirmatively to having consumed some type of medication. The drugs that registered the highest consumption prevalence were analgesics (53.09%). It should be stressed here that 8.75% of the not economic immigrant population has consumed antibiotics. The variables that were independently and significantly associated with a greater probability of medication consumption were: sex, age, presence of chronic disease, use of alternative medicines and a negative perception of health. The most strongly associated variable is medical consultation. Conclusions The prevalence of medication use higher among economic immigrant women. In our population, the use of alternative medicines use and medical visits to the physician are associated with higher consumption. Copyright © 2009 John Wiley & Sons, Ltd. [source]