Complex Clinical Questions Research Articles

Endometriosis and infertility

Women with endometriosis typically present with pelvic pain, infertility or an adnexal mass. Surgery for persistent adnexal masses may be indicated to remove an endometrioma or other pelvic pathology. Surgical or medical therapy is efficacious for pelvic pain due to endometriosis, but treatment of endometriosis in the female partner of an infertile couple raises a number of complex clinical questions that do not have simple answers.

Endometriosis and infertility

Women with endometriosis typically present with pelvic pain, infertility or an adnexal mass. Surgery for persistent adnexal masses may be indicated to remove an endometrioma or other pelvic pathology. Surgical or medical therapy is efficacious for pelvic pain due to endometriosis, but treatment of endometriosis in the female partner of an infertile couple raises a number of complex clinical questions that do not have simple answers.

Diagnosing major depression in the elderly: Evidence for response bias in standardized diagnostic interviews?

Recent epidemiological and family genetic studies in different countries using standardized diagnostic interviews for mental disorders have rather consistently demonstrated considerably lower current (e.g. ECA Study: 0.9%) and lifetime (1.4%) prevalence estimates of Major Depression in the elderly (older than 65 years of age) as compared to younger age groups (e.g.30–44 years: 1 year, 3.9%; lifetime, 7.5%). Some investigators have questioned the validity of these data and suggested alternative interpretations. One possibly is that the complex standardized symptom and clinical probe questions, and the required judgemental processes inherent in diagnostic interviews exceed the cognitive capacity of older adults. This may result in systematic response bias. This paper examines the degree to which the lower prevalence estimates of depression in the elderly are biased due to specific characteristics of the assessment strategy. Analyses of epidemiologic data from the Munich Follow-up Study (MFS), based on the Diagnostic Interview Schedule, demonstrate that (1) older respondents report lifetime depressive symptoms with the same frequency as younger respondents. The additional probe questions designed to identify the degree to which symptoms were caused by factors other than psychological revealed that (2) the elderly more often attribute such symptoms to physical illnesses or conditions. This results in (3) the exclusion of the reported symptoms as a basis for diagnosing depression. A laboratory study demonstrated that “working memory capacity” was a good predictor of this response behavior, indicating that the complexity of the formalized questions exceeds the cognitive capacity of the elderly. Attributing symptoms to a physical illness or condition might be a heuristic strategy to simplify complex recall and judgement processes; the resulting answer is plausible but incorrect. We recommend that the symptom and probe questions of standardized diagnostic interviews be simplified, especially for use with the elderly.

To Soothe or Not to Soothe—Or When and How: Neurobiological and Learning-Psychological Considerations of Some Complex Clinical Questions

(1990). To Soothe or Not to Soothe—Or When and How: Neurobiological and Learning-Psychological Considerations of Some Complex Clinical Questions. Psychoanalytic Inquiry: Vol. 10, How Theory Shapes Technique: Perspectives on a Self-Psychological Clinical Presentation, pp. 554-566.

A 10-year review of the Teaching Hospital-Based National Drug and Toxicology Information Service in Zimbabwe.

The drug and toxicology information service (DaTIS), at the Department of Pharmacy, University of Zimbabwe Medical School, was set up in 1979. The service is mainly delivered to health professionals and to a lesser extent to the community. The DaTIS is designed to help solve complex clinical questions. Most of the requests are made by telephone. Urgent questions may be initially answered by telephone, or a phone call can be returned after in-depth documentation. A complete answer with references may be written and sent to the enquirer. Written non-urgent questions may be sent a few days to a few weeks later. This report is based on a systematic review of records compiled over the period between January 1983 and July 1988. Of the 1,000 requests received and recorded during the period under consideration, approximately 750 (75%) were on drug information and 250 (25%) were on poisoning or toxicological information. The most common causes of poisonings were due to organophosphate pesticides and fertilizers, Elephant's Ear, Amanita Phalloides mushroom, medicines affecting the central nervous system, e.g. tranquilizers, psychotropics, and chemicals, especially those used for hair relaxing. Only the first three causes of poisoning are discussed in detail. Most of the queries relating to poisoning, especially those received during the night, were not recorded. These results confirm the need for an adequate number of qualified and committed manpower to share the work-load in DaTIS as well as in teaching, research and in the continuous health education of the community. The results obtained by DaTIS and a recent survey (14) indicate that Zimbabwe has a big poisoning problem, especially with regard to pesticides and treatments recommended by the traditional healer. Education and information dissemination to health professionals, workers and the general public on the toxic agents concerned are vital and, although steps have been taken in this direction, much still remains to be done. Moreover, the report confirms the importance of the service to health professionals and the community in the country and the SADCC (Southern African Development Conference Committee) region as a whole.