Assessing communication competence: a review of current tools.

Background: The assessment of communication competence has become a major priority of medical educational, policy, and licensing organizations in the United States and Canada. Multiple tools are available to assess communication competence, but there are few studies that compare the tools.

Methods: A consensus panel of six family medicine educators evaluated 15 instruments measuring the physician-patient interview.

Managing your collections with excellence.

Collections are an important key to medical practice success. This article is a guide to the collections process. Some of these steps may seem obvious, but often medical practice administrators get busy managing people and forget to manage their collections.

Treatment of migraine headaches with sumatriptan in pregnancy.

Objective: To review the literature for treatment of migraine headaches with sumatriptan during pregnancy.

Data Sources: Studies and reports were located in International Pharmaceutical Abstracts (1970-September 2003) and MEDLINE (1966-week 3 September 2003).

Data Synthesis: Research has been performed to evaluate the risk of teratogenesis after sumatriptan exposure in pregnant patients.

Viral skin infections: preventing outbreaks in sports settings.

Viral skin infections, such as herpes simplex, molluscum contagiosum, and warts, are common in athletes. Visual inspection alone can often provide a diagnosis. The Tzanck test or a direct fluorescent antibody test for herpes simplex virus 1 and 2 can also establish an early diagnosis.

Hand and wrist injuries: Part I. Nonemergent evaluation.

Diagnosis of upper extremity injuries depends on knowledge of basic anatomy and biomechanics of the hand and wrist. The wrist is composed of two rows of carpal bones. Flexor and extensor tendons cross the wrist to allow function of the hand and digits.

Diagnosis and treatment of herpes zoster: role of the nurse practitioner.

Data Sources: Case example and review of clinical trials, meta-analyses, and reviews provide relevant data regarding the management of herpes zoster.

Conclusions: Herpes zoster is a relatively common disease in elderly patients. It results from reactivation of varicella zoster virus (chickenpox).

Possible Link Between Attention-Deficit/Hyperactivity Disorder and Reproductive Complications.

BACKGROUND: Initially conceptualized as a disorder of childhood, attention-deficit/hyperactivity disorder (ADHD) is now emerging as a chronic disorder that may present in adolescence and persist into adulthood. Failure to recognize this common disorder in childhood may lead to disabling comorbid symptoms and a poor long-term prognosis in adulthood. Young adults with undiagnosed ADHD experience significant psychiatric comorbidity, including high rates of drug dependency and lower levels of global functioning.

Evaluation of a cardiovascular health program for participants with mental retardation and normal learners.

An evaluation was conducted to compare the impact of an 8-week cardiovascular disease risk reduction group teaching program for 92 individuals with mental retardation (MR; IQ less than 70) and 97 normal learners. The curriculum emphasized exercise, nutritional choices, and stress reduction. Body Mass Index (BMI; weight in kilograms, divided by height in meters, squared), knowledge of healthy eating choices, self-report of fruit and vegetable intake, and exercise were measured before and after the intervention.

Atypical presentation of spontaneous discitis: case report.

Background: Spontaneous discitis is primarily a pediatric illness. Adult patients usually present at an average age of 69 years with a history of diabetes or with a systemic infection. The lumbar spine is the most frequent site of infection (54%), and the cervical is the least at 10%.

Tremor.

Tremor, a rhythmic, involuntary, oscillatory movement of body parts, is the most common movement disorder. Tremors are classified as rest or action tremors. Rest tremor occurs when the affected body part is completely supported against gravity.

ADHD treatment and academic performance: a case series.

Most new cases of attention deficit-hyperactivity disorder (ADHD) are of the predominantly inattentive subtype. Research on the use of psychostimulants in these patients has shown a high rate of nonresponders. Although psychostimulants showed a short-term decrease in symptoms in students diagnosed with predominantly inattentive ADHD, they did not significantly improve grade-point averages.

Use of and attitudes toward complementary and alternative medicine among family practice patients in small rural Illinois communities.

Context: Complementary and alternative medicine (CAM) use continues to increase in the United States. Data on rural patients' use and extent of integration of CAM with conventional medicine are lacking, although this is a population often associated with use of "folk remedies" and self-care strategies.

Purpose: To examine rural primary care patients' attitudes toward and use of CAM.

The role of algorithms in the detection and treatment of depression in primary care.

Many depressed patients present to primary care physicians instead of psychiatrists, and several studies have found that primary care physicians underdiagnose and undertreat depression. Primary care physicians may fail to diagnose and treat depression for many reasons: depression as it appears in primary care is in many ways a different disease than that seen in the psychiatric setting, and the process of detecting and treating it is different as well. Primary care clinicians face 2 main tasks when addressing depression in routine practice: to accurately identify those patients who are most likely to benefit from antidepressant treatment and to provide the best treatment options possible in the limited time available per visit.

Consultation in paediatric rehabilitation for behaviour problems in young children with cerebral palsy and/or developmental delay.

To measure the effectiveness of consultation for behaviour problems in a paediatric rehabilitation setting, this paper used longitudinal assessment of children who received the intervention through their regularly scheduled appointments with their Occupational Therapist (OT), Physical Therapist (PT) or Speech and Language Pathologist (SLP) at three paediatric rehabilitation clinics in Columbia, South Carolina. The participants were 86 children with cerebral palsy (CP), developmental delay (DD) and medical conditions, ages 1-6 years, and their families. The intervention consisted of monthly meetings between rehabilitation therapists and a team consisting of a Child Psychiatrist, Developmental Pediatrician, Psychologists and a Preventive Medicine specialist.

Benefits and risks of psychiatric medications during pregnancy.

Traditionally, psychiatric medications were withheld during pregnancy because of fear of teratogenic and other effects. The emergence of evidence of the safety of most commonly used psychiatric medications, the availability of this information in the form of online databases, and the documentation of the adverse effects of untreated maternal mental illness have all increased the comfort of physicians and patients with respect to the use of psychiatric medications during pregnancy. The tricyclic antidepressants and fluoxetine (Prozac) appear to be free of teratogenic effects, and emerging data support similar safety profiles for the other selective serotonin reuptake inhibitors.

Managing benign prostatic hyperplasia.

Medical and surgical options for the treatment of benign prostatic hyperplasia have expanded in recent years. Saw palmetto, the most widely used complementary medication, is less effective than standard medical therapy but has fewer side effects. Although non-selective alpha blockers provide rapid relief of symptoms and are relatively inexpensive, they can cause dizziness and orthostatic hypotension.

Teaching the teachers: helping faculty in a family practice residency improve their informatics skills.

Faculty members in family practice residencies are increasingly being asked to help residents develop skills in the use of informatics and evidence-based medicine (EBM). In order to do this successfully the teachers themselves must be skilled in the use of these tools. Recognizing the need for such training, the Maine Medical Center Family Practice Residency Program designed a faculty development project to increase knowledge and skills in the use of information technology.