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PubMedDate not supplied

Medical and pharmacologic management of upper extremity neuropathic pain syndromes.

Written from a neurologic and therapeutically conservative perspective, this review advocates fundamentally medical and pharmacologic management of upper extremity neuropathic pain syndromes, including chronic regional pain syndromes, formerly classified reflex sympathetic dystrophy (RSD) and causalgia. Mandatory steps include, first, a prompt serious attempt to localize the nerve lesion whenever possible using complete, sophisticated neurologic examinations, then thoughtfully selected conventional neurophysiologic and radiologic tests. Strongly discouraged are promiscuous use of "RSD" to describe all neuropathic pains, and diagnostic reliance upon thermography and uncontrolled sympathetic blocks. Conservative multidisciplinary diagnostic and treatment teams should often possess a nucleus of neurologist and hand therapist, plus additional consultants including psychiatric. Every physician and therapist managing neuropathic pain must consider psychologic and wellness issues within their responsibilities. Prompt referral to an experienced surgeon is crucial for decompression or repair of relevant, significant, objectively proven (ideally neurophysiologically) nerve and root lesions. Ambiguous professional colloquialisms, "central pain" and "central sensitization," unfortunately provide value-laden pretexts for premature invasive treatments, and animate the truly dreadful concept "central RSD". Various classes of conventional oral non-narcotic adjuvant analgesics are reviewed, and the inevitability of their empiric, non-formulaic administration. No patient-specific, rationally-identifiable molecular receptor/switch can be deduced clinically or tripped mechanistically to terminate chronic pain. Two promising new non-narcotic centrally-active medications, gabapentin and tramadol, are highlighted as harbingers of future progress. The neglected subtle art of prescription writing is stressed, particularly for medication-sensitive patients. Medical cost containment should promote critical, long overdue outcomes studies comparing conservative and invasive pain treatments.

Analgesics↗
PubMedDate not supplied

Present and future trends with NLP.

This paper reflects some desiderata on the role of Natural Language Processing (NLP) in the coming years as foreseen in the medical domain. During the Medical Informatics Europe (MIE) conference in 1997, the NLP track was composed by numerous papers on natural language, knowledge representation, nomenclatures and classifications. Indeed, the medical community is looking for solutions for the future which are going to emerge from more powerful desktop and for which the successful softwares of tomorrow are not yet identified. Presently this same community's needs remains unsatisfied with healthcare professionals writing at best their patient medical records in a text processing system. We stand today closer to the typewriter than to any modern solution which could radically transform the treatment of information related to patients. What kind of hurdles are there still in front of us before we reach this new territory?

Europe↗
PubMed1996

Protocol for writing cause-of-death statements for deaths due to natural causes.

The purpose of this article is to describe a protocol that provides suggestions and guides the clinical practice of writing cause-of-death statements for death certificates, autopsy reports, and other medical documents. The 16 members of the Autopsy Committee of the College of American Pathologists (CAP), Northfield, Ill, were appointed by the CAP officers based on demonstrated interest and expertise in autopsy performance and reporting. The committee perceived a need for specific instructions aimed at promoting consistency, accuracy, and completeness when writing cause-of-death statements. Development of a protocol was supported by CAP after approval by the CAP board of governors. The framework for the protocol was based on recommendations of the National Center for Health Statistics, Hyattsville, Md, with additional concepts added by the autopsy committee. The protocol for writing cause-of-death statements for natural causes is expected to foster consistency, accuracy, and completeness in the writing of cause-of-death statements. The quality of individual death certificates, autopsy reports, and national mortality data may improve through protocol usage. Application of the protocol principles should impose no ongoing costs at any user level because no new products or personnel are required for its application.

Autopsy↗
PubMed2004

Teaching and learning about written communications in a United Kingdom medical school.

CONTEXT: Written communications have a long history in medicine. Today, doctors spend a significant part of their work time completing paper work. Although the importance of accurate written communications is acknowledged, medical curricula rarely include focused teaching on this topic. OBJECTIVES: The aim of this paper is to assess the feasibility of a teaching session for second-year medical students aimed at raising their awareness of written communications in the context of health care. METHODS: Immediately after the session, students and tutors completed written evaluations of their experiences. Four months after the session the entire cohort completed a knowledge test, and scores of attendees and non-attendees were compared. FINDINGS: Three of four learning objectives were completely met by at least half of the students and the exercises were rated as helpful. Students' and tutors' comments identified specific aspects of the session that require improvement, in particular, developing the exercise on patient-centred written communications. Students who attended the session scored significantly higher in a relevant knowledge test than non-attendees. DISCUSSION: The session provided students with the knowledge to identify patient-centred written communications and other features of effective writing in the context of medical care. CONCLUSIONS: Introducing the topic early in the medical curriculum may prove valuable in establishing effective practice. Providing students with opportunities to revisit this important topic throughout their medical education may also be beneficial. The long-term impact of the session needs to be evaluated.

Curriculum↗
PubMed2001

['Caring always'; physicians' expression of condolences to the relatives of patients].

According to the WHO definition, palliative care does not end with the death of the patient, but also includes supporting the family members in dealing with the loss. A recent article refers to the importance of physicians writing letters of condolences. The letter of condolences marks the end of the treatment relationship. Writing such a letter can assist the physician in distancing him/herself from the death of his/her patient, and the letter can also help the family adjust to life without the deceased patient. The letter can also remove any distrust that may exist towards the medical profession. Reasons for not writing a letter of condolences include an own feeling of failure, administrative difficulties, indifference or incapacity. Nevertheless, writing a letter of condolences is an integral part of the care provided by the physician to the patient and his/her relatives.

Attitude to Death↗
PubMed1993

What is medical ethics?

This article is the first of a series on medical ethics which will appear at irregular intervals in the JOURNAL of the Louisiana State Medical Society. The ethical issues which will cover many of the problems encountered in clinical practice that cause a dilemma for physicians and patients. In these cases a choice usually exists and one describes the situation with words such as "should" or "ought." The author will write about current issues in medical ethics. His goal will be to describe a problem and to present the arguments for and against various solutions. He does not intend to tell you how you should react to ethical issues; that is each person's judgment. On the other hand, he will try to give you the arguments and hopes to help you to see the issue from several perspectives.

Choice Behavior↗
PubMed2004

The relationship of usability to medical error: an evaluation of errors associated with usability problems in the use of a handheld application for prescribing medications.

This paper describes an innovative approach to the evaluation of a handheld prescription writing application. Participants (10 physicians) were asked to perform a series of tasks involving entering prescriptions into the application from a medication list. The study procedure involved the collection of data consisting of transcripts of the subjects who were asked to "think aloud" while interacting with the prescription writing program to enter medications. All user interactions with the device were video and audio recorded. Analysis of the protocols was conducted in two phases: (1) usability problems were identified from coding of the transcripts and video data (2) actual errors in entering prescription data were also identified. The results indicated that there were a variety of usability problems, with most related to issues of ease of use. In addition, other problems were identified which were related to limitations of the content of the program. In examining the relationship between usability problems and errors, it was found that certain types of usability problems were closely associated with the occurrence of specific types of errors in prescription of medications. Implications for the improvement of safety of health care information systems are discussed.

Computers, Handheld↗
PubMed1992

Care of the dying: an ethical and historical perspective.

OBJECTIVE: To provide a historical perspective, from ancient Greece to the middle of the 20th century, on ethical issues and principles commonly associated with medical care for the dying in Western civilization. SOURCES: Writings of noted philosophers, historians, ethicists, and physicians, as well as published legal and ethical guidelines. INFORMATION EXTRACTION: The sources used highlight the origins of various ethical principles associated with care of the dying. They also identify the opinions of prominent individuals throughout the history of medical ethics. SUMMARY: Devotion to medical beneficence, concern for the quality of life, and respect for the sanctity of life are all expressed in the earliest medical and philosophical writings of ancient Greece. With regard to care of the dying, these considerations led to a wide acceptance of avoiding or terminating treatment in hopeless cases. They also led to active debate regarding medicine's role in hastening the dying process. The rise of Christianity during the Middle Ages markedly suppressed such debate by strongly reinforcing the principle of sanctity of life. Later, the optimism of the enlightenment added the hope of prolonging life. Finally, modern advances in medical science have made that hope a reality of complex ethical dimensions. CONCLUSIONS: Ethical debates regarding appropriate care for the dying are as old as medicine itself. Although beneficent concerns have characterized the medical community in almost every period of history, tensions have repeatedly arisen as diverse religious and philosophical ideologies have produced varying standards to define such beneficence. In the Christian world, the sanctity of life was often extolled as the paramount standard. For the ancient Greeks and Romans, and again in many post-Renaissance philosophies, quality of life considerations assumed equal or greater importance. Modern life-prolonging technologies heighten the debate by allowing these two standards to dramatically conflict, particularly in the critical care setting.

Beneficence↗
PubMedDate not supplied

Literature search in medical publications.

The quality of a medical publication rests as much on the research paper as on the literature search prior to writing for publication. The art of literature search and its importance to the various steps in scientific writing have been emphasised in this paper. Many medical authors in West African sub-region learned the art of publishing research work through their senior professional colleagues or by trial and error through the peer review experience of their work. This article is expected to fill this gap in training. It should guide trainee specialists or new entrants, who must do literature search towards publishing research works for earning promotion, advancing knowledge, obtaining grants and fellowship awards, into the "publish or perish" syndrome existing in academic institutions. The current trend of electronic writing has called for a new style of referencing in medical publications, which has been suggested in this paper.

Africa, Western↗
PubMedDate not supplied

[The first São Paulo meeting on mental health services for college students].

The authors initially describe the main psychological problems observed among medical students. After that, they write briefly about the history of the psychological support to the college student in Brazil. Next, they present a summary of the First São Paulo Meeting on Mental Health Services for College Students. Finally, they point out the main topics presented in the meeting, like the identity of the Service, its specificity, its institutional role, the ideal working setting and its ethical questions. Current working conditions for medical professionals and some characteristics of Contemporary Medicine were also discussed.

Brazil↗
PubMed2004

A testimony to Muzil: Hervé Guibert, Foucault, and the medical gaze.

Testimony to Muzil: Hervé Guibert, Michel Foucault, and the "Medical Gaze" examines the fictional/autobiographical AIDS writings of the French writer Hervé Guibert. Locating Guibert's writings alongside the work of his friend Michel Foucault, the article explores how they echo Foucault's evolving notions of the "medical gaze." The article also explores how Guilbert's narrators and Guibert himself (as writer) resist and challenge the medical gaze; a gaze which particularly in the era of AIDS has subjected, objectified, and even sometimes punished the body of the gay man. It is argued that these resistances to the gaze offer a literary extension to Foucault's later work on power and resistance strategies.

Acquired Immunodeficiency Syndrome↗
PubMed1975

Multiple choice questions. The debate goes on.

The clinical comprehensive examination given to Pahlavi University medical students in their last year was designed to include three types of questions: multiple choice questions (MCQ's) testing factual recall, MCQ's measuring clinical problems solving ability, and simulated patient management problems (PMP's). The scores of the three types of questions were compared with the five-year cumulative class standing and with each other. It was found that the class standing was very highly correlated with MCQ's testing for recall of information. The relation progressively lessened with problem solving MCQ's and PMP's. In the extremes of class standing there was no significant correlation with problem solving MCQ's and a significant but negative correlation with PMP's. Similar results were obtained when recall type MCQ's were compared with problem solving MCQ's and PMP's. It is concluded that the various determinants of class standing (MCQ's, oral exams, 'performance' reports, etc) are probably based on ability for factual recall and that the usual variety of MCQ's are a poor discriminating index of medical competence. It is, however, possible to write MCQ's that are better able to measure the more significant objectives of medical education.

Education, Medical, Undergraduate↗
PubMed1996

Morris Fishbein, M.D.: the "medical Mussolini" and chiropractic.

Morris Fishbein, M.D. is the most important non-chiropractor to influence the chiropractic profession. From his post as editor and secretary of the American Medical Association, his anti-chiropractic writings, speeches and political activities had a profound effect on the profession's development. Because he was not only the foremost medical politician of the time, but also perceived as a multi-faceted author on public health issues, his credibility was high across large sections of the population and in most social institutions. His tactics and stature undoubtedly helped keep the profession limited to caring for a small percentage of the population. Because of him, chiropractors devised survival strategies that continue to influence the profession even today.

Chiropractic↗
PubMed2001

Effects of future writing and optimism on health behaviors in HIV-infected women.

Optimists (people who have positive expectations about the future) have been shown to perform more health-promoting behaviors than pessimists. This study attempts to alter individuals' levels of optimism, and thereby their health behaviors, by having them write about a positive future. HIV-infected women (N = 40) on combination therapies were randomly assigned to write about a positive future or assigned to a no-writing control group. Among participants who were low in optimism, the writing intervention led to increased optimism, a trend toward increased self-reported adherence to medications, and decreased distress from medication side effects, compared to controls who did not write. Participants who were high in optimism showed the opposite effects after writing about the future. Results suggest that a future-oriented writing intervention may be apromising technique to increase medication adherence and decrease symptom distress in pessimistic individuals.

Adolescent↗
PubMed2000

Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions.

Because many preventable medication errors occur at the ordering stage, a program for improving the quality of writing inpatient orders and outpatient prescriptions at one institution was developed. To determine whether potential problems existed in the order-writing process for inpatients, all physician orders for a seven-day period in 1997 were reviewed (n = 3740). More than 10% of all orders had illegible handwriting or were written with a felt-tip pen, which makes NCR copies difficult to read. Other potential errors were also identified. Following educational programs for physicians and residents focusing on the importance of writing orders clearly, physician orders were reviewed for a 24-hour period (n = 654). The use of felt-tip pens decreased to 1.37% of all orders, and no orders had illegible handwriting. A similar quality improvement approach was used to evaluate the outpatient prescription-writing process. A review of all new prescriptions for a consecutive seven-day period at a local hospital-owned community pharmacy (n = 1425) revealed that about 15% of the prescriptions had illegible handwriting and roughly 10% were incomplete. Additional data were gathered through a survey sent to 71 outside provider pharmacies requesting information on problems related to prescriptions written by physicians from the institution; 66% responded. Failure to print prescriber name (96%), illegible signature (94%), failure to include DEA number (89%), and illegible handwriting other than signature (69%) were reported as the main problems. Each physician was given a self-inking name stamp to use when writing prescriptions. In addition, educational programs covering examples of poorly written prescriptions and the legal requirements of a prescription were held for physicians and residents. A follow-up survey showed that 72% of pharmacies saw stamps being used; when stamps were not used, however, illegible signatures continued to be a problem. Follow-up reviews of outpatient prescriptions indicate improvements in handwriting and completeness, but continuing educational efforts are needed. The quality of order writing for inpatients and outpatients continues to be monitored on a regular basis. Ongoing educational programs, follow-up reminders, and feedback to physicians have greatly improved the prescription-writing habits of physicians.

Ambulatory Care↗