We investigated the impact on patients' satisfaction and understanding of their condition and treatment recommendations when the care provider dictated the medical record in their presence. Providers' satisfaction and perceptions were also ascertained. Sixty patients were randomly placed into a treatment group where the provider dictated the medical record in their presence, and 60 patients were placed in a standard visit control group. Volunteer providers included residents, a faculty physician, and a physician assistant. A survey instrument completed with an interviewer measured patients' satisfaction with the provider, their care, the dictation technique, and their understanding of their diagnosis and treatment recommendations. The provider completed a similar questionnaire. Patients in both the dictation and control group were equally satisfied with their care, felt they understood what the provider told them about their medical conditions, and felt they understood their provider's recommendations. Within the dictation group, 44 (73%) liked the process, 24 (40%) believed they were helped to understand their condition, 22 (37%) believed they were helped in understanding recommendations, and 23 (38%) reported improved satisfaction with a visit that included dictation in their presence. In the dictation group, men felt more positive than women about dictation in their presence, including increased understanding of their condition and satisfaction with the visit. Patients aged 56 years and older were also more positive about dictation in their presence, including improvement in their understanding of the provider's recommendations. Providers were equally satisfied with encounters using either method.

Adult↗

PubMedDate not supplied

Langerhans' cell histiocytosis: head and neck manifestations in children.

BACKGROUND: Langerhans' cell histiocytosis (LCH) is an uncommon, poorly understood granulomatous disease, characterized by the idiopathic proliferation of Langerhan's cells or their marrow precursors. In 1985, the Philadelphia Work-shop adopted the term "Langerhans' cell histiocytosis" (LCH) to differentiate it from reactive and neoplastic causes of histiocytosis. METHODS: This study includes 73 pediatric patients diagnosed with this condition in Dublin, Ireland, and Nottingham, England, during a 34-year period (1959 to 1993). These patients are reviewed with respect to clinical presentation, difficulty with making a histological diagnosis, their management, and outcome. RESULTS: A total of 49 patients (67%) had head and neck involvement. Bony involvement was the most frequent sign, most frequently located in the skull. There were 11 deaths (15%) in this series, all associated with multisystem disease, and nine of these deaths were in children younger than 2 years of age. CONCLUSIONS: The role of otolaryngologists is important in the early and accurate evaluation, staging, and diagnosis of LCH. It may mimic more common diseases, such as otitis externa, acute mastoiditis, skin rash, gingivitis, or cervical lymphadenopathy. Patients with multisystem disease may be so ill at presentation that the head and neck lesions may be overlooked. The current management of LCH has become increasingly conservative, and in the 1990s, fewer cases are given chemotherapy or radiotherapy. The prognosis is very good for single-system disease and poor for multisystem disseminated disease with early onset.

Adolescent↗

PubMedDate not supplied

Inflammation and Alzheimer's disease pathogenesis.

Appreciation of the role that inflammatory mediators play in Alzheimer's disease (AD) pathogenesis continues to be hampered by two related misconceptions. The first is that to be pathogenically significant a neurodegenerative mechanism must be primary. The second is that inflammation merely occurs to clear the detritis of already existent pathology. The present review addresses these issues by showing that 1) inflammatory molecules and mechanisms are uniquely present or significantly elevated in the AD brain, 2) inflammation may be a necessary component of AD pathogenesis, 3) inflammation may be sufficient to cause AD neurodegeneration, and 4) retrospective and direct clinical trials suggest a therapeutic benefit of conventional antiinflammatory medications in slowing the progress or even delaying the onset of AD.

Alzheimer Disease↗