Diverse Medical Specialties Research Articles

Patient Satisfaction in Obstetrics and Gynecology: Individualized Patient-centered Communication

Background Patient satisfaction is becoming an increasingly prevalent topic in medicine, but little is known about patient satisfaction in women's health and other specialties. We review current methods of improving patient satisfaction in the field of obstetrics and gynecology with the intent to increase patient satisfaction even further by enhancing and combining previously used strategies. Methods A search from inception to June 2010 for electronic literature was performed using Medline. The search strategy used the medical subject heading terms “patient satisfaction”, “obstetrics”, “gynecology”, “patient-centered communication”, “communication training”, and “malpractice”. The company websites for Press Ganey Associates, Inc and Integrated Health Associates' were also reviewed. Studies in both general medicine and the field of obstetrics and gynecology were reviewed to emphasize disparities between patients' satisfaction in diverse medical specialties. Results Studies indicating the importance of patient satisfaction, the factors contributing to patient satisfaction, and an evaluation of current, evidence-based methods of increasing patient satisfaction were reviewed. The studies included suggest that current methods of assessing/improving patient satisfaction are effective, but may not be the most productive. Conclusions We expect that the combination of previously successful methods of improving patient satisfaction to allow physicians to employ individualized patient-centered communication may improve patient satisfaction even further. Studying the use of our proposed enhancements in physician-patient communication may be worthwhile tools to increase patient satisfaction and optimize the quality of women's healthcare.

Multidisciplinary Evaluation of Patients With Suspected Lung Cancer

Lung cancer diagnosis and treatment has evolved to require the input and expertise of multiple diverse medical and surgical specialties. The approach to lung cancer patients requires the adherence to a few principles that include thorough use of staging modalities to assure the proper treatment for each patient, and an understanding of the limitations and advantages of each of these modalities. Evidence is continuing to emerge that supports the notion that diagnostic workup and treatment of lung cancer patients is best done within the context of a multidisciplinary team devoted to this purpose.

Pandemic influenza: human rights, ethics and duty to treat

The 2009 influenza A/H1N1 pandemic seems to be only moderately severe. In the future, a pandemic influenza with high lethality, such as the Spanish influenza in 1918-1919 or even worse, may emerge. In this kind of scenario, lethality rates ranging roughly from 2% to 30% have been proposed. Legal and ethical issues should be discussed before the incident. This article aims to highlight the legal, ethical and professional aspects that might be relevant to anaesthesiologists in the case of a high-lethality infectious disease such as a severe pandemic influenza. The epidemiology, the role of anaesthesiologists and possible threats to the profession and colleagueship within medical specialties relevant to anaesthesiologists are reviewed. During historical plague epidemics, some doctors have behaved like 'deserters'. However, during the Spanish influenza, physicians remained at their jobs, although many perished. In surveys, more than half of the health-care workers have reported their willingness to work in the case of severe pandemics. Physicians have the same human rights as all citizens: they have to be effectively protected against infectious disease. However, they have a duty to treat. Fair and responsible colleagueship among the diverse medical specialties should be promoted. Until disaster threatens humanity, volunteering to work during a pandemic might be the best way to ensure that physicians and other health-care workers stay at their workplace. Broad discussion in society is needed.

Jean-Martin Charcot and his vibratory chair for Parkinson disease

Vibration therapy is currently used in diverse medical specialties ranging from orthopedics to urology to sports medicine. The celebrated 19th-century neurologist, J.-M. Charcot, used vibratory therapy to treat Parkinson disease (PD). This study analyzed printed writings by Charcot and other writers on vibratory therapy and accessed unpublished notes from the Salpêtrière Hospital, Paris. Charcot lectured on several occasions on vibratory therapy and its neurologic applications. He developed a vibration chair for patients with PD after he observed that patients were more comfortable and slept better after a train or carriage ride. He replicated this experience by having patients undergo daily 30-minute sessions in the automated vibratory chair (fauteuil trépidant). His junior colleague, Gilles de la Tourette, extended these observations and developed a helmet that vibrated the head on the premise that the brain responded directly to the pulsations. Although after Charcot's death vibratory therapy was not widely pursued, vibratory appliances are reemerging in 21st century medicine and can be retested using adaptations of Charcot's neurologic protocols.

Disorders of Sex Development: Improving Care for Affected Persons and Their Families

Back to table of contents Previous article Next article Letters to the EditorFull AccessDisorders of Sex Development: Improving Care for Affected Persons and Their FamiliesKATRINA KARKAZIS Ph.D., M.P.H.,KATRINA KARKAZIS Ph.D., M.P.H.Search for more papers by this author,Published Online:1 Feb 2008https://doi.org/10.1176/appi.ajp.2007.07101555AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: In their clinical case conference, published in the October 2007 issue of the Journal , J. Michael Bostwick, M.D., and Kari A. Martin, M.D., (1) correctly pointed out that clinical management of intersex conditions is highly controversial. They failed to note, however, two recent and important developments aimed at improving care in this area. One recent development is the Consensus Statement on Management of Intersex Disorders (2) . This document, which grew out of a conference of 50 international experts in diverse medical specialties, marked the first time researchers and clinicians thoroughly revisited the medical standard of care for diagnoses of intersex conditions since John Money and his associates first proposed treatment standards in the 1950s. Participants agreed to recommend several important changes to care that demonstrate a significant shift in thinking for the treatment of intersexuality. Owing to the recognition that patients and parents (and even clinicians) find the terminology and labels surrounding intersex conditions confusing and stigmatizing, participants adopted a new nomenclature in which intersex was replaced by the more general descriptor “disorders of sex development,” which refers to congenital conditions in which chromosomal, gonadal, or anatomical sex development is atypical. Terms such as hermaphroditism and gender-based diagnostic labels are to be replaced with clinically descriptive terms (e.g., androgen insensitivity syndrome). Acknowledging that there are minimal systematic outcome data pertaining to genital surgery, that orgasmic capability may be harmed by such surgery, and that there is little documentation to support the widely held belief that early surgery relieves parental distress about atypical genitals, the Consensus Statement on Management of Intersex Disorders states that surgery should only be considered for young girls with “severe” genital virilization. Participants also noted that psychological care should be integral to medical care, that homosexuality should not be construed as an indication of incorrect gender assignment, and that the potential for fertility—originally emphasized for female gender assignment only—should be an important consideration for male gender assignment as well. The second development is the publication of the Clinical Guidelines for the Management of Disorders of Sex Development in Childhood and the Handbook for Parents (3, 4). Outlining a patient-centered model of care, these guidelines were developed in consultation with clinical specialists, affected individuals and their families, and patient support groups. Much remains to be done to improve care for persons and families affected by disorders of sex development. However, these two developments are important steps in that direction.Palo Alto, Calif.Dr. Karkazis reports no competing interests.This letter (doi: 10.1176/appi.ajp.2007.07101555) was accepted for publication in November 2007.

Screening for congenital cataracts: A cost‐consequence analysis of eye examination at maternity wards in comparison to well‐baby clinics

To estimate, on a national basis in Sweden, the costs versus consequences of combined maternity ward and well-baby clinic eye screening compared to well-baby clinic screening alone. Two scenarios were created and compared regarding healthcare costs: visual acuity development and quality-adjusted life-years (QALYs). One scenario represented early management (combined maternity ward and well-baby clinic screening); the other represented less early management (well-baby clinic screening only). Each scenario was based on 100,000 births, and the healthcare costs were calculated from detection until age 18 y. All estimates of prevalence, visual outcome, postoperative complications and screening procedures were based on previous, recently published studies. Estimated costs were obtained from St. Erik's Eye Hospital in Stockholm and the University Hospital of Lund, at 2001 prices. Total cost of the maternity ward/well-baby clinic screening scenario was 7.9 million SEK, and that of the maternity ward screening scenario was 6.9 million SEK. The incremental cost-effectiveness ratio was estimated at 234,000 SEK/QALY provided three more children per year were detected in Sweden by mandatory maternity ward/well-baby clinic screening. The incremental expense of introducing combined maternity ward/well-baby clinic eye screening on a nationwide basis is cost effective and within acceptable levels of cost/QALY when compared with other widely accepted therapies across diverse medical specialties.

Comorbidity in depression.

To define the extent of comorbidity in depression. The level of medical comorbidity in depression was assessed on the basis of the empirical literature and results from the National Institute of Mental Health (NIMH) conference on Depression's Toll on Other Illnesses. The global incidence of depression underscores the need to develop integrative treatment strategies for these disorders. An NIMH conference entitled 'The Unwanted Cotraveler: Depression's Toll on Other Illnesses' has highlighted the impact of increased depression prevalence in the presence of medical disorders. Economic data from a large health insurance claims database concludes that the presence of a psychiatric condition, particularly depression, considerably increases the medical costs, as well as the cost of caring for the psychiatric condition. Federally sponsored research intervention centres need to address these issues and provide opportunities for diverse medical specialties to collaborate on testing novel treatment approaches.

A cost-utility analysis of interventions for severe proliferative vitreoretinopathy

PURPOSE: The purpose of this study was to report a reference case, patient preference-based, incremental, cost-utility analysis for treatments of retinal detachment associated with severe proliferative vitreoretinopathy (PVR). DESIGN: Computer-based economic model utilizing data from the Medicare health insurance system in the United States. METHODS: A cost-utility analysis compared vitreoretinal surgery using expanding gases and silicone oil therapy to the natural course of retinal detachment associated with severe PVR. The model applies long-term published visual data from the Silicone Study Group, time tradeoff utility analysis, decision analysis with Markov modeling, and discounting of costs and health benefits as per the Panel on Cost-Effectiveness in Health and Medicine. The major outcome measure was in year 2000 United States dollars per quality-adjusted life-year ($/QALY) gained. RESULTS: Vitreoretinal surgery for retinal detachment complicated by severe PVR, as compared with no treatment, resulted in a mean gain of 0.128–0.200 discounted (3% annual rate) quality-adjusted life-years per treated patient. Silicone oil ($/QALY gained of $40,252) was slightly more cost-effective than perfluoropropane (C 3F 8) gas ($/QALY gained of $46,926) in eyes with PVR without previous vitrectomy, whereas C 3F 8 gas ($/QALY gained of $46,162) was more cost-effective than silicone oil ($/QALY gained of $62,383) with previous vitrectomy and PVR. Sensitivity analysis resulted in a $/QALY gained of $13,347 when 10% of opposite eyes had a severe visual loss to $202,128 when a discount rate of 10% was utilized and opposite eyes initially had good vision. CONCLUSIONS: The incremental expense of interventions for retinal detachment associated with PVR is cost-effective when compared with other widely accepted interventional therapies across diverse medical specialties.

THE VALUE COMPONENT OF EVIDENCE-BASED MEDICINE

THE VALUE COMPONENT OF EVIDENCE-BASED MEDICINE

A core curriculum for entering graduate medical education trainees

The Graduate Medical Dental Education Consortium of Buffalo—consisting of the School of Medicine and Biomedical Sciences, the School of Dental Medicine, and eight affiliated hospitals of the University at Buffalo—developed a core curriculum of topics of multidisciplinary importance for the orientation of all first‐year residents who will receive their graduate medical education (GME) training in the participating hospitals. More than 120 faculty members representing diverse fields and medical specialties cover topics including medicolegal issues, teaching skills, and advanced cardiac life support. The faculty and residents cooperated in the revision and refinement of the program. This is the first identifiable report of such a comprehensive educational program serving the needs of a diverse audience. It provides a model which demonstrates how a consortium can nurture close working relationships and deliver cost‐effective educational innovations in GME.

Physicians as criminal defendants: Specialty, sanctions, and status liability.

Contrary to the commonly held notion that high occupational status shields a deviant individual from sanctions, some theorists have proposed a negative relationship between punishment and status when the offending behavior is of low to moderate seriousness, but a positive relationship when it is of high seriousness. This phenomenon has been termed “status liability,” and previous research suggests that physicians are especially vulnerable to its effect. The present study examines status liability in terms of diverse medical specialties to determine whether status differences among specialists produce measurably different public reactions to deviance. Results follow the pattern predicted by the status liability hypothesis. The findings also suggest policy implications in such judicial areas as voir dire, Medicaid, fraud enforcement, and malpractice litigation.

Pharmacotherapeutic evaluation and the psychiatric setting.

Once again we are immersed in a period of intense interest in pharmacotherapy in psychiatry. The recent advent of chlorpromazine, reserpine, pipradrol (Meratran) and its derivatives, meprobamate (Miltown), etc., has catalyzed interest in the field, and our specialty journals are filled with enthusiastic reports. Physicians in diverse medical specialties frequently prescribe these drugs to patients with almost any variety of affective component in their symptom pattern. Such an intensely hopeful response once again reflects the unfulfilled therapeutic needs of the psychiatric profession, which potentiate the hope of quick closure for many problems. It is natural to empathize with those persons responsible for therapeutic programs in our state hospitals when they become enthusiastic over a new type of therapy. They have the greatest needs and the largest immediate responsibility of the profession. At present, as a group, they are very enthusiastic about the new drugs, and this is of profound social