[Writing manuscripts].
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Clinical Trials as Topic↗
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Your research: how to get it on paper and in print.
Much worthwhile medical research is never accepted for publication or is ignored when published, often because it is poorly presented. The purpose of this article is to express in simple language how research is best presented in writing. Few actual data are given, though much experience is summarized. The result desired is greater ease, clarity, and effectiveness in communicating medical research. The principles presented here are intended to make medical research writing easier and clearer and to give the research itself more impact.
Child↗
Strategies of influence in medical authorship.
The notion of a rhetoric of science argues that scientific writing is not unproblematically neutral and objective, but rather laden with both theory and value and necessarily persuasive. The nature of persuasion within the profession of medicine is studied here through an analysis of rhetorical strategies at work in medical journal articles. (All articles are on the subject of functional headache and appear after 1982 in such journals as the Journal of the American Medical Association, The Lancet, The New England Journal of Medicine and Headache.) The analysis is organized using the Aristotelian categories of invention (the discovery or creation of arguments), arrangement (their organization in the most persuasive order) and style (including such matters as the use of the passive voice and the avoidance of figurative language). The result of the analysis is a comprehensive inventory of strategies medical authors use in order to influence their peers. The inventory provides a vocabulary and a procedure for analysis of medical rhetoric in general; that is, it goes some way to enabling a medical metadiscourse. The analysis further suggests that rhetorical studies, as a discipline, has much to contribute to medicine's project of examining its own assumptions and scrutinizing its own dominant paradigm. Identifying rhetorical strategies at work in medical journals is one way to articulate medical values and to understand them as instruments of action within the profession.
Authorship↗
[Diagnosis of illiteracy in patients hospitalized at a nursing service. Prospective study].
UNLABELLED: When, at the end of a medical visit, a doctor prescribes medication, he may be unaware that writing is unknown to the patient. This fact compromises the patient's understanding of disease and therapeutics and thus the importance of diagnosing illiteracy. The A.A studied prospectively 200 consecutive patients admitted to a Medical Ward at Santa Maria Hospital in Lisbon, from 13/3/1997 to 8/7/1998. The study included age, gender, social environment, evaluation of the ability to read and write, years of scholarship and the principal diagnosis. The results were to chi 2 (Yates) and Student's T-tests. RESULTS: 94 patients were male and 106 female, aged between 18 and 95 years (mean 62.3), 106 from an urban environment, 54 from a rural environment and 37 had lived their adult life in a rural environment but were at present living in an urban environment. The percentage of illiteracy was 30.5%, being considerably higher in the females (43.4%) than in the males (15.96%), in patients above 65 years (49%) compared to patients from 15 to 64 years old (12%), in non-urban patients (55%) opposed to urban born patients (10.4%). Any of these variables, gender, age and social environments had statistical significance to P < 0.001 when associated to illiteracy. CONCLUSIONS: The comparative analysis of the official results for the general Portuguese Population study, Census 91, shows an important analogy. In both studies illiteracy was worst in females and in those above 65 years of age. Today illiteracy is still days a serious National problem, with important medical implications, a troublesome obstacle to the understanding of the disease and compliance with therapy.
Adolescent↗
How to Write a Scientific Paper and Get if Published.
Despite the high expectation for publication of medical articles, many medical students do not receive as much guidance in writing papers as was once the case. The authors discuss the major priorities in targeting a specific journal and preparing a manuscript that requires minimal revision.
Journal Article↗
Teaching communication skills: a skills-based approach.
OBJECTIVES: The purpose of this project was to design structured training activities to emphasize key points about patient-physician communication. Effective communication has been shown to enhance patient satisfaction, compliance with treatment, and medical decisions and outcomes. Basic communication skills and behavioral-change interview skills are taught. DESCRIPTION: Communication is a core "building block" of a four-semester, two-year Essentials of Clinical Medicine Course (ECM), which is in its second year of existence. Four interactive lab sessions have been designed, each with structured learning exercises. At the beginning of each session, students work in groups of 30 completing activities based on videos developed by the Bayer Institute for HealthCare Communication.(1) Subsequently, two groups of three students each work with a behavioral or physician facilitator. A formal training and administration manual for all activities has been developed and an evaluation system developed and implemented. Session 1, "Initial Interview Skills," teaches opening, mirroring, and encouraging non-interrogation activities. Session 2, "Empathic Responses," includes activities entitled "Cue Detection," "Accurate Empathy," and "Getting the Story Straight." In Session 3, "Obtaining an HPI," students view an exemplary medical interview, then role-play computerized cases(2) and practice the HPI data collection based on clinical facts taken from the computerized cases. During the Session 4, "Putting It All Together," students interview a standardized patient (SP) for five to seven minutes and receive and give feedback from peers, SPs, and facilitators. Subsequent to the communication lab, students conduct six physician-supervised patient interviews practicing their medical interviewing skills and write-ups. Two subsequent small-group sessions include "group" interviews of SPs in which students assess readiness for behavioral change (e.g., quitting smoking, losing weight) and also learn to conduct more "difficult' health-promotion conversations (e.g., sexual behavior, alcohol use). Evaluation methods include the use of a professional behavior evaluation form completed by communication facilitators and small-group leaders. This assessment form consists of ratings on: reliability and responsibility, relationships with others, self-improvement and adaptability, upholding professional standards, and communication skills dimensions. A formal interview-behavior checklist is used during the training and in the feedback sessions. Finally, SP OSCEs of communication and behavioral-change interviewing occur at the end of the first year of training. DISCUSSION: The communication labs have been well received by students. Students have reported increased understanding of their upcoming roles as physicians, have stated they have gained insights about the importance of connecting with patients in order to give them proper medical treatment, and have requested additional training in communication. Students have reported increased confidence in their interviewing skills prior to interactions with "actual" patients, and clinical preceptors have reported increased levels of preparedness among students who have participated in the structured learning experience. Future plans include adding communication training with problem patients, and about end-of-life and other challenging issues.
Communication↗
Glycopyrrolate treatment of drooling in an adult male patient with cerebral palsy.
1. The aim of the study was to assess the effect of glycopyrrolate on drooling in an adult male patient with cerebral palsy. 2. After a thorough medical examination and consent in writing by the responsible guardian, a baseline sum score for frequency and seriousness of drooling was established over a 2 week period in addition to data on shifts of handkerchiefs, urination, defecation and observation of behaviour. Glycopyrrolate (1 mg) tablets were then administered, starting with one tablet daily the third week and increasing the daily dose by one tablet per week until a maximum of four tablets during week six and 4 days of week seven when the daily dose was reduced to two tablets for 3 days. For the four weeks 8-11 three tablets were given daily. In week 12 the dose was reduced to two tablets and for the weeks 13-15 no tablets of glycopyrrolate were given. 3. For as long as the patient received three to four tablets of glycopyrrolate daily, drooling was markedly reduced and handkerchiefs were not necessary on some days. After the tablets were withdrawn drooling increased to approximately the same level as it was before treatment. No adverse medical, psychological, or social effects were observed. 4. For shorter periods, glycopyrrolate can be given in controlled doses provided that an adequate medical assessment has been undertaken.
Cerebral Palsy↗
[Glycopyrrolate treatment for drooling in an adult with cerebral palsy].
BACKGROUND: The aim of the study was to assess the effect of glycopyrrolate on drooling in an adult male patient with cerebral palsy. MATERIAL AND METHODS: After a thorough medical examination and consent in writing from his guardian, a baseline sum score for frequency and seriousness of drooling was established over a two-week period in addition to data on shifts of bibs, urination, defecation and observation of behaviour. Glycopyrrolate (1 mg) tablets were then administered, starting with one tablet daily the third week and increasing the daily dose by one tablet per week until a maximum of four tablets during week 6 and four days of week 7, when the daily dose was reduced to two tablets for three days. In the four weeks 8-11, three tablets were given daily. In week 12 the dose was reduced to two tablets and for the weeks 13-15 no glycopyrrolate was given. RESULTS: As long as the patient received three to four tablets of glycopyrrolate daily, drooling was markedly reduced, and bibs were not necessary on some days. After withdrawal, drooling increased to approximately the same level as before treatment. INTERPRETATION: For shorter periods, glycopyrrolate can be given in controlled doses provided that an adequate medical assessment has been undertaken.
Administration, Oral↗
HOW TO WRITE A DISABILITY REPORT. I. RESPIRATORY IMPAIRMENT.
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Disability Evaluation↗
Electronic spreadsheet vs. manual payroll.
Medical groups with direct employees must employ someone or contract with a company to compute payroll, writes Michael Kiley, Ph.D., M.P.H. However, many medical groups, including small ones, own a personal or minicomputer to handle accounts receivable. Kiley explains, in detail, how this same computer and a spreadsheet program also can be used to perform payroll functions.
Accounts Payable and Receivable↗
Write a departmental handbook for junior staff.
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Humans↗
Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients.
PURPOSE: Expressing emotions and finding benefits regarding stressful experiences have been associated in correlational research with positive adjustment. A randomized trial was performed to compare effects of experimentally induced written emotional disclosure and benefit finding with a control condition on physical and psychological adjustment to breast cancer and to test whether outcomes varied as a function of participants' cancer-related avoidance. PATIENTS AND METHODS: Early-stage breast cancer patients completing medical treatment were assigned randomly to write over four sessions about (1) their deepest thoughts and feelings regarding breast cancer (EMO group; n = 21), (2) positive thoughts and feelings regarding their experience with breast cancer (POS group; n = 21), or (3) facts of their breast cancer experience (CTL group; n = 18). Psychological (eg, distress) and physical (perceived somatic symptoms and medical appointments for cancer-related morbidities) outcomes were assessed at 1- and 3-month follow-ups. RESULTS: A significant condition x cancer-related avoidance interaction emerged on psychological outcomes; EMO writing was relatively effective for women low in avoidance, and induced POS writing was more useful for women high in avoidance. Significant effects of experimental condition emerged on self-reported somatic symptoms (P =.0183) and medical appointments for cancer-related morbidities (P =.0069). Compared with CTL participants at 3 months, the EMO group reported significantly decreased physical symptoms, and EMO and POS participants had significantly fewer medical appointments for cancer-related morbidities. CONCLUSION: Experimentally induced emotional expression and benefit finding regarding early-stage breast cancer reduced medical visits for cancer-related morbidities. Effects on psychological outcomes varied as a function of cancer-related avoidance.
Adaptation, Psychological↗
Strategic aspects of prescription writing.
The strategic aspects of the written medical prescription, often overlooked, include fulfillment of the placebo, make-believe, and temporizing effects of prescribing; the patient's expectations to receive and participate in the choice of therapy; and the physicians's need for action. Prescribing requires fine judgement as to which drug to use, when to give it, and in what quantity and frequency.
Consumer Behavior↗
[Diagnostic management of the thyroid nodule. National Agency for the Development of Medical Evaluation].
Several partners worked together to write the recommendations concerning the diagnostic management of thyroid nodules in accordance with the methodology developed by ANDEM for writing Recommendations for Clinical Practice. There are several reasons for these recommendations: earlier controversies are still debated, clinical practice is multidisciplinary and varied, diagnostic methods have changed but their diffusion has been variable, and finally, there are no formal recommendations for clinicians on this subject.
Female↗
Prescription-writing by pediatric house officers.
Prescription-writing is an important aspect of medical practice. Illegible and/or incorrect prescriptions can result in loss of patient, physician, and pharmacist time and may cause therapeutic errors or drug toxicity. An examination to evaluate prescription-writing was administered to a group of pediatric house officers and faculty. Follow-up monitoring of actual prescriptions written in the pediatric clinic was performed. Deficient prescription-writing techniques and weakness in the therapeutic knowledge of beginning pediatric interns were identified. The data indicate that proper prescription-writing (especially the use of controlled substances) should be taught to house officers and that the therapeutic knowledge of beginning pediatric interns cannot be assumed to be adequate.
Arizona↗
Reflecting on practice to theorise empowerment for women: using Foucault's concepts.
The aim of this research is to understand how power operates in the medical encounter with the childbearing woman and to theorize ways in which midwives can empower women to experience control over what happens to them. Thirty-three Australian pregnant young women and the researcher participated in this study. A post-modern, feminist praxis approach was the research method used. Data was collected using participant observation, in-depth interviewing and reflective journaling. Data was analysed using Michel Foucault's theoretical concepts concerning disciplinary power/knowledge. Key theoretical findings are: knowing how power operates allows midwives to predict what will happen if the woman is intending to resist standardised medical birthing practices. When disciplinary medical power is used the purpose is to coerce patients to do what the doctor wants. Power and knowledge are inseparable, as each strengthens the other, thus Foucault writes of a single concept--Power/Knowledge. Medical power operates most effectively with the co-operation of the midwife and the submission of the childbearing woman. Medical power is normally invisible; it only becomes visible when resistance is encountered, whereupon rewards, threats and punishments are used in an attempt to gain submission. Women can be more empowered if the midwife shares knowledge, not just about pregnancy, labour and birth, but also about the woman's legal rights and what might happen if she decides to refuse standardised medical care. In this way women's empowerment can be facilitated so that they are more likely to experience the type of childbirth they desire.
Adolescent↗
ScriptWriter. A relational database to manage outpatient medical treatment.
ScriptWriter is database software designed to replicate the process of a physician writing a prescription. The software also includes standard demographic and progress note information; however the focus of the software is on automating the process of writing prescriptions. The software is especially adept at creating patient medication lists, generating medication histories and keeping track of medication expiration dates. Other strengths include its ability to organize patient assignments and assist in the generation of progress notes. The application is network capable and fully graphical. A psychiatric outpatient clinic is currently using the software. Practitioners in non-psychiatric settings can also benefit from the software.
Ambulatory Care↗
"Eye injuries" by the Byzantine writer Aetios Amidinos.
The authors give a short report of the "Injuries of the Eye" by the Byzantine writer Aetios Amidinos. He wrote 16 medical books, among them "The 7th Logos", including Eye Diseases. In all his writings, there is a substantial resort to ancient medical literature, mainly to the books of Galen. He describes the Eye Injuries in 5 chapters with remarkable critical ability and suitable treatment. Thus he is acknowledged as one of the most cultured and productive writers of that period.
Eye Injuries↗