Rapid assessment of literacy levels of adult primary care patients

Health education materials, medical instructions, consent forms, and self-report questionnaires are often given to patients with little regard for their ability to read them. Reading ability is rarely tested in medical settings. The Rapid Estimate of Adult Literacy in Medicine (REALM) was developed as a quick screening tool to assist physicians in identifying patients with limited reading skills and in estimating patient reading levels. This information can be used to tailor materials and instructions to patients' abilities. The REALM and the reading sections of the Peabody Individual Achievement Test-Revised and the Slosson Oral Reading Test were used to test reading ability in 207 adults in six public and private primary care clinics. REALM scores correlated highly with those of the standardized reading tests. The REALM, which takes three to five minutes to administer and score, appears to be a practical instrument to estimate patient literacy in primary care, patient education, and medical research.

Screening depression in primary care: back to the basics with a new tool

Two depression inventories were used to screen 377 family practice patients. One, the Self-Rating Depression Scale (SDS), assesses major symptomatology; it is the depression inventory most frequently used in family practice. The other, the Depression Adjective Checklist (DACL), assesses mood only and has not been previously reported in the family medicine literature. Forty-one percent of the patients who completed the SDS rated themselves at least mildly depressed; 37% scored in the same range on the DACL. Four percent of the patients scored in the severe depression range on the SDS, while 15% scored in the severe depression range on the DACL. Residents treating these patients, however, failed to diagnose depression in more than 85% of the patients who had rated themselves as at least mildly depressed on either inventory. The residents also failed to diagnose depression in more than 70% of those who had rated themselves as severely depressed. Teaching and research implications are discussed.

Diagnosing depression in primary care: a practical, interdisciplinary review and a call for change

Because recognizing depression is of critical importance, we have organized a comprehensive review of current literature on medical, psychiatric, and behavioral science to give primary care physicians a brief, practical, and multidisciplinary survey of diagnostic approaches to depression. The review is also designed to help clarify the disparate approaches, definitions, theories, and classifications of depression found in the literature. We emphasize two emerging perspectives important to primary care physicians in their understanding and treatment of depression. The first is a wider view of masked depression, and the second is depressive behavior related to family and cultural systems. Traditional classifications may have limited applicability to the patient families most often seen in primary care. We hope that the paper will serve as a challenge to physicians to combine open and creative observation with inductive reasoning in the creation of a more useful system for classifying depression in primary care.

Chronic vulvovaginitis in children due to Shigella flexneri

Although previous reports have implicated Shigella flexneri in resistant or chronic cases of vulvovaginitis in children, no authors have described the clinical findings of this condition. The report presents four cases of persistent vulvovaginitis in prepubertal Indian girls from different reservation communities in Arizona. S. flexneri was isolated in pure culture from the vaginal discharge of each patient. All four cases were characterized by a prolonged vaginitis with a bloody, purulent discharge which responded poorly or not at all to various topical modes of therapy for nonspecific vaginitis. Three cases cleared completely when treated with orally given ampicillin for one week. The striking similarity of these cases suggests that chronic Shigella vulvovaginitis is a recognizable clinical entity and should be considered in the differential diagnosis of persistent vaginitis in children, especially in those from communities where Shigella is endemic.

Ampicillin failure in H. influenzae meningitis. A case report with added commentaries

The authors describe a child whose H. influenzae menin gitis persisted despite relatively high-dose ampicillin ther apy. They raise the question whether longterm morbidity from H. influenzae meningitis may be greater with ampicil lin than with the older chloramphenicol-penicillin treatment. Two experts were asked to discuss this question in the light of this case report. Their comments follow the main paper.

Practolol in treatment of supraventricular cardiac dysrhythmias

Practolol (I.C.I. 50172) was used to treat supraventricular dysrhythmias in 32 patients with a rapid ventricular rate and with heart disease of varied aetiology. In 26 patients the average reduction in ventricular rate was 75 per minute, while immediate reversion to sinus rhythm occurred in three patients. The slowing effect was mainly due to a direct action on the atrioventricular node. The effectiveness of practolol was unrelated to the type of dysrhythmia or its aetiology. No serious adverse clinical effects were noted.