A Case Study of Intractable Vomiting with Final Diagnosis of Neuromyelitis Optica.

This case study presents a patient living in a suburban/rural community who received appropriate referral to secondary and tertiary care for nausea and vomiting, accompanied by waxing and waning neurological symptoms, yet proved difficult to diagnose. This patient is presented to draw attention to a rare neurological disorder which should be included in the differential diagnosis of nausea and vomiting with some key neurological complaints, even in the absence of physical findings.

The symbolic and material nature of physician identity: implications for physician-patient communication.

This field study considers the implications of the symbolic and material nature of physician identity for communication with patients. In-depth interviews of physicians across multiple organizational contexts reveal that physician identity is a discursive process of situated meaning in which particular configurations of beliefs, values, and actions are constructed within specific contexts. The content of individual physician identity was related to the general environment of medicine and its local medical context.

Physician discussion about social activities in primary care encounters with older adults.

Objective: Involvement in social activities is linked to positive health outcomes. This study focused on the prevalence of social activity discussions during the primary care medical encounter, and examined how patient, physician, and contextual factors were associated with discussions between physicians and older patients.

Methods: The research was a secondary analysis of 434 videotapes recorded during primary care medical visits between 1998 and 2000 in outpatient clinics.

Learning basic surgical skills with mental imagery: using the simulation centre in the mind.

Context: Although surgeons and athletes frequently use mental imagery in preparing to perform, mental imagery has not been extensively researched as a learning technique in medical education.

Objective: A mental imagery rehearsal technique was experimentally compared with textbook study to determine the effects of each on the learning of basic surgical skills.

Methods: Sixty-four Year 2 medical students were randomly assigned to 2 treatment groups in which they undertook either mental imagery or textbook study.

A reliable and valid instrument to assess competency in basic surgical skills in second-year medical students.

Background: Despite calls for competency based education, a dearth of validated instruments for measuring basic skills currently exists. We developed an instrument to assess competency in basic surgical skills in second-year medical students and tested it for psychometric reliability and validity.

Methods: From a review of the literature, an instrument comprised of numerically scaled items was constructed.

Reaching and teaching preceptors: limited success from a multifaceted faculty development program.

We conducted a six-pronged preceptor faculty development program that included a listserve and interactive Web-based teaching scenarios. A total of 144 preceptors in a required preceptorship program were offered traditional continuing medical education (CME), a preceptor listserve, an electronic clinical teaching discussion group, an orientation videotape, a CD-ROM on teaching skills, and technology support. On Web-based evaluation, 31% of participants responded.

Decision or no decision: how do patient-physician interactions end and what matters?

Background: A clearly stated clinical decision can induce a cognitive closure in patients and is an important investment in the end of patient-physician communications. Little is known about how often explicit decisions are made in primary care visits.

Objective: To use an innovative videotape analysis approach to assess physicians' propensity to state decisions explicitly, and to examine the factors influencing decision patterns.

Prevalence and correlates of doctor-geriatric patient lifestyle discussions: analysis of ADEPT videotapes.

Background: This study identifies the prevalence and correlates of physician-geriatric patient discussions about physical activity and nutrition lifestyle behaviors.

Methods: Between August 1998 and July 2000, 423 older patient visits to 36 physicians were videotaped in three different primary care settings. The patient sample was primarily white, female, well-educated, and financially sufficient, although 12.

Understanding primary care physicians' propensity to assess elderly patients for depression using interaction and survey data.

Objective: The objective of this study was to examine primary care physicians' propensity to assess their elderly patients for depression using data from videotapes and patient and physician surveys.

Study Design: An observational study was informed by surveys of 389 patients and 33 physicians, and 389 videotapes of their clinical interactions. Secondary quantitative analyses used video data scored by the Assessment of Doctor-Elderly Patient Transactions system regarding depression assessment.

An efficient method of identifying major depression and panic disorder in primary care.

The research literature is replete with evidence of and concerns about the prevalence and undertreatment of mental disorders in primary care. Although screening, on its own, may not directly affect clinical outcomes, it is still the most efficient and effective way to identify psychologically distressed patients for either research purposes or to provide patients with or refer patients to appropriate care. The current study sought to establish the utility of the MHI-5 for the detection of patients suffering from major depression or panic disorder, two of the most common psychiatric conditions seen in primary care settings.

Interpretation of chest radiographs in infants with cough and fever.

An understanding of the appearance of the infant chest radiograph requires an understanding of the anatomy and the physiologic, immunologic, and pathologic processes in the infant's chest. The authors describe the features of the infant chest that most influence the appearance of the chest radiograph in infants with cough and fever. They discuss why confusion sometimes occurs when radiology residents and general radiologists familiar with adult chest radiographs first evaluate the infant chest radiograph.

Attitudes of veterinary medical students and medical students toward collaborative learning: an experiment.

This study measured the attitudes of 55 medical students and 30 veterinary medical students as they participated in an experiment of collaborative teaching and learning about basic surgical skills. Two parallel forms of an attitude questionnaire were developed, with three subscales: confidence in one's own surgical skill; collaboration with the other type of student; and inter-professional collaboration in general. These attitude scales were administered before and after an experiment involving the veterinary medical students teaching the medical students incision and exploratory laparoscopy in a laboratory setting using live rabbits.

Overcoming obstacles to work-changing technology such as PACS and voice recognition.

Objective: When implementing picture archival communication systems (PACS) and voice recognition (VR) technology in radiology, management attention generally has focused on justifying the system financially, investigating potential vendors, developing timelines for hardware delivery, installing the software, developing interfaces, and tracking and measuring results. These are critical components in implementing PACS and VR technology, but not sufficient for success.

Conclusion: This article argues that the ability to view organizational issues related to changing how people do their work from multiple organizational perspectives is equally important in determining the success of PACS and VR projects.

Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students.

Objective: The purpose of this study was to test the effects of varying the amount of physical practice and mental imagery rehearsal on learning basic surgical procedures.

Study Design: Using a sample of 65 second-year medical students, 3 randomized groups received either: (1) 3 sessions of physical practice on suturing a pig's foot; (2) 2 sessions of physical practice and 1 session of mental imagery rehearsal; or (3) 1 session of physical practice and 2 sessions of imagery rehearsal. All participants then performed a surgery on a live rabbit in the operating theater of a veterinary college under approved conditions.

Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients.

This study evaluated the psychometric characteristics of the Beck Depression Inventory-II (BDI-II; A. T. Beck, R.

Preconsultation education promoting breast cancer screening: does the choice of media make a difference?

Background: Multimedia technology can be a valuable resource for health promotion and patient education initiatives because it allows messages to be presented within an environment that is both sensory-rich and interactive (i.e., the user can explore the information according to his or her particular needs and interests).

Technical cost of radiologic examinations: analysis across imaging modalities.

Purpose: To determine the individual technical costs of general diagnostic radiographic, ultrasonographic (US), computed tomographic (CT), magnetic resonance (MR) imaging, and scintigraphic examinations and interventional radiology.

Materials And Methods: The Radiology Cost and Productivity Benchmarking Study method of the University HealthSystem Consortium, a cooperative group of academic medical centers, was modified and extended to the six imaging modalities in a tertiary care academic setting. Hospital billing and cost records were analyzed for fiscal year 1996.