Biomedical subjects

Claude Richard

Publications and source records attributed to Claude Richard.

13 recordsLinked to original sources

PubMed2006

MEDICODE: an instrument to describe and evaluate exchanges on medications that occur during medical encounters.

OBJECTIVE: To examine the psychometric properties of MEDICODE, a coding instrument developed to assess medication discussions during medical consultations. METHODS: Inter-coder reliability, test-retest stability, and concurrent validity with the Roter Interaction Analysis System (RIAS) and predictive validity with the Medical Interview Satisfaction Scale (MISS) were calculated. RESULTS: Inter-coder reliability and test-retest stability for medication class and status were both very good. Inter-coder agreement and test-retest stability for theme identification were mostly over 90%. Kappa values for theme identification varied from acceptable to excellent for 21 of the 29 and for 26 of the 37 Kappa coefficients that could be calculated. The mean percent agreement between MEDICODE and RIAS for medication class was of 96.8% and the mean Kappa value was 0.83. Although the mean percent agreement for the presence of a theme in MEDICODE and RIAS was 81%, the average Kappa coefficients were lower at 0.40. However, each of the four broad theme categories had its share of themes with robust Kappa values. We found significant positive correlations (p<0.05) between discussions of medication main effects and instructions with patient satisfaction. CONCLUSION: With a reasonable amount of training, the coders were able to produce reliable and valid measures of discussions of medications during medical consultations. PRACTICAL IMPLICATIONS: MEDICODE will facilitate the study of the impact of the nature and intensity of discussions about medications during consultations on patient medication knowledge, medication recall and compliance.

Abstracting and Indexing↗

PubMed2006

Nature and frequency of exchanges on medications during primary care encounters.

OBJECTIVE: To describe the exchanges, related to discussion of all medications during primary care medical consultations. METHODS: Descriptive study of audio recordings of 422 medical encounters. Coding was done with MEDICODE, a validated instrument developed to analyse verbal exchanges on medications. The unit of analysis is the medication. RESULTS: An average of 3.9 medications (S.D.=2.8; range 1-21) are discussed per interview and 4.2 themes are broached for each drug (S.D.=2.6; range 1-17). "Active Discussed", "Represcribed" and "Newly Prescribed" drugs account for 43.1, 16.3 and 10.6%, respectively of all medications discussed. Themes most often discussed are Name, Instructions, Observed Main Effect, Class, Reasons for Taking the Drug, General Use of the Medication, Expected Effect on Symptoms, Form of the Medication, Indications Another Consultation Needed, and Alternative Medication. The least often discussed themes include clinically significant ones such as Possible Adverse Effects, Observed Adverse Effects, Expression of Attitudes and Emotions with regard to the medication, Compliance and Warnings. The average number of themes discussed differed between medications that were prescribed during the encounter, either New prescriptions or Represcribed drugs, compared to medications that were only discussed during the encounter. CONCLUSION: Our results show that medication discussions are heterogeneous and vary with the status of the medication and the theme. Also, the nature and extent of the discussions about medications do not support the shared-decision making model. PRACTICE IMPLICATIONS: Though it is too soon to make specific recommendations about discussions on medications, it seems clear that information-sharing about medications during medical encounters is a process that extends beyond any single encounter. Although communication skills are now part of most medical curriculums, there is an obvious need to put forth the concept of patient medication knowledge-building over multiple physician-patient encounters and to better prepare physicians to use the specific content and process skills necessary to revisit issues related to medications that seem necessary to support their patients' medication-taking practices.

Abstracting and Indexing↗

PubMed2006

Nonlinear processing of the output voltage of a piezoelectric transformer.

Reducing the size of power supplies raises the problem of new components that could be better candidates for integration. In this field, electromagnetic transformers may be replaced with significant benefit by piezoelectric transformers (PT). In a PT, the input electrical energy is transferred to the output by an acoustical means, using the direct and converse effects of piezoelectric materials. Its main advantages over an electromagnetic transformer are no magnetic noise generation, small size, high power density, and high efficiency. This paper deals with an innovative technique that produces a significant improvement of the power capability of piezoelectric transformers. This technique is based on a particular output voltage processing of the PT. Its effect is a vibration level reduction of the PT structure while keeping the output power practically constant. Vibration level is a critical parameter that determines the maximum power capability of a given PT. Thus, the new processing reduces significantly the losses of the PT. Both theoretical predictions and experimental results show that the increase of the power capability may reach 200%.

Journal Article↗

PubMed2006

Single crystals and nonlinear process for outstanding vibration-powered electrical generators.

This paper compares the performances of vibration-powered electrical generators using a piezoelectric ceramic and a piezoelectric single crystal associated to several power conditioning circuits. A new approach of the piezoelectric power conversion based on a nonlinear voltage processing is presented, leading to three novel high performance power conditioning interfaces. Theoretical predictions and experimental results show that the nonlinear processing technique may increase the power harvested by a factor of 8 compared to standard techniques. Moreover, it is shown that, for a given energy harvesting technique, generators using single crystals deliver 20 times more power than generators using piezoelectric ceramics.

Journal Article↗

PubMed2005

Intercultural communication competence in family medicine: lessons from the field.

OBJECTIVE: To describe the challenges for immigrant patients and their physicians and their skills in intercultural communication (ICC). METHODS: We videotaped one clinical encounter for each of 24 psychologically distressed patients visiting their regular family physician. The physician and the patient, each separately, viewed the videotape of their clinical encounter and commented on important moments identified by the participant or the researchers. RESULTS: Patients and/or physicians lacked knowledge of the effects of culture on the doctor-patient relationship and expressions of distress as well as the effects of immigrant-specific stress on health. Most subjects were motivated to have an interpersonal, rather than an intercultural encounter. Physicians and patients demonstrated the skills needed to achieve an interpersonal encounter. Some physicians and their patients achieved intercultural meetings as a result of their interpersonal interactions over a period of years. DISCUSSION: Lack of formal training partly explains why most participants demonstrated an elementary level of ICC. In addition, Identity Management Theory and Co-cultural Theory explain some of the barriers to ICC. PRACTICE IMPLICATIONS: Providing physicians with formal training in intercultural communication and empowerment training for patients is likely to improve the quality of care of immigrants.

Adaptation, Psychological↗

PubMed2005

Toward energy harvesting using active materials and conversion improvement by nonlinear processing.

This paper presents a new technique of electrical energy generation using mechanically excited piezoelectric materials and a nonlinear process. This technique, called synchronized switch harvesting (SSH), is derived from the synchronized switch damping (SSD), which is a nonlinear technique previously developed to address the problem of vibration damping on mechanical structures. This technique results in a significant increase of the electromechanical conversion capability of piezoelectric materials. Comparatively with standard technique, the electrical harvested power may be increased above 900%. The performance of the nonlinear processing is demonstrated on structures excited at their resonance frequency as well as out of resonance.

Journal Article↗

PubMed2005

Doctor-patient communication: complaints and legal actions.

Explore the source record for details and available documents.

Canada↗

PubMed2004

GHQ-28 and cGHQ-28: implications of two scoring methods for the GHQ in a primary care setting.

BACKGROUND: The General Health Questionnaire allows for distinguishing patients suffering from psychiatric problems from those in good mental health. There is some controversy as to the best scoring method. Two different methods have been proposed: GHQ and cGHQ. The present study aims at verifying whether there is confirmation of the hypothesis that the population resulting from the cGHQ calculation presents greater chronicity. METHOD: A total of 40 general practitioners and 1145 of their patients in the Greater Montreal area, Québec, Canada participated in the original study. A sub-group of 313 patients were followed over a 3-month period. The patients were asked to complete a set of questionnaires, including the GHQ-28. The traditional method of calculating the GHQ score and the alternative cGHQ method were used. RESULTS: Two discordant groups of patients were identified: Group 1 (acute cases only), positive on the GHQ, but negative on the cGHQ (n = 124), and Group 2 (chronic cases only), negative on the GHQ and positive on the cGHQ (n = 64). Patients in Group 2 were older (p<0.001), were more worried about their health (p = 0.06) and their health problem had lasted for a longer time (p = 0.02). Patients in Group 2 were twice as likely to remain positive on the GHQ and/or the cGHQ as those in Group 1 in the 1- and 3-month follow-ups. CONCLUSIONS: The results suggest the presence of notable differences between the two groups, generally explainable by the hypothesis of greater chronicity in the cGHQ patients. The results confirm the impact of the choice of calculation method on the composition of the two groups. Finally, the authors suggest using the two calculation methods simultaneously.

Adult↗

PubMed2004