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Salmon P, Peters S, Stanley I. Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis. BMJ (CLINICAL RESEARCH ED.) 1999; 318:372-6. [PMID: 9933202 PMCID: PMC27727 DOI: 10.1136/bmj.318.7180.372] [Citation(s) in RCA: 206] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe, from the perspective of patients, distinguishing features of doctors' attempts to explain the symptoms of somatisation disorders. DESIGN Qualitative analysis of verbatim records of interviews in which patients recounted doctors' explanations of their symptoms. SETTING Patients with persistent somatising symptoms referred from general practices in Liverpool and St Helens and Knowsley were interviewed before entry into a treatment programme. SUBJECTS 228 of 324 patients referred were interviewed. Initial interviews were used to develop the process and technique, and the final analysis was based on a subsample of 68 records, randomly chosen from the transcripts of 188 subjects who were interviewed subsequently. RESULTS Doctors' explanations were often at odds with the patients' own thinking. Analysis showed that medical explanations could be grouped into one of three categories, defined by the patients' perceptions. Most explanations were experienced as rejecting the reality of the symptoms. An intermediate category comprised explanations that were viewed as colluding, in which the doctor acquiesced with the patients' own biomedical theories. However, a few explanations were perceived by patients as tangible, exculpating, and involving. These explanations were experienced by patients as satisfying and empowering. CONCLUSIONS Patients with somatisation disorders feel satisfied and empowered by medical explanations that are tangible, exculpating, and involving. Empowering explanations could improve these patients' wellbeing and help to reduce the high demands they make on health services.
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Abstract
IMPORTANCE Chronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world's female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions. OBSERVATIONS Chronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process. CONCLUSIONS AND RELEVANCE Chronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.
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Review |
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Bischoff A, Bovier PA, Rrustemi I, Gariazzo F, Eytan A, Loutan L. Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral. Soc Sci Med 2003; 57:503-12. [PMID: 12791492 DOI: 10.1016/s0277-9536(02)00376-3] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of this study was to determine whether language barriers during the screening interview affected the reporting of asylum seekers' health problems and their referral to further health care. Seven hundred and twenty-three standard screening questionnaires, administered by nurses to asylum-seekers at the time of entry into Geneva/Switzerland between June and December 1998, were reviewed, as well as information pertaining to language use during the interview. Language concordance between nurses and asylum seekers was assessed by considering the presence/absence of an interpreter, the type of interpreter present (trained, untrained), and the nurse's self-assessed proficiency in the language used during the medical interview. Nurses also recorded their own subjective assessment of the overall quality of communication during the interview. More than half of the asylum seekers came from Europe, mainly the Balkan regions, and a third of them from Africa. Most asylum seekers were men (72%). The median age was 26.5 years, and 50% were younger than 25 years. Severe physical and psychological symptoms were reported by 19% and traumatic events prior to migration were reported by 63%. The nurses referred 36% of all refugees to further medical care and 6% to psychological care. Professional interpreters were used in 8% of the interviews and ad hoc interpreters in 16%. Adequate, partial and inadequate language concordance was reported for 54%, 27% and 18% of the consultations respectively. Adequate language concordance was significantly associated with higher reporting of past experience of traumatic events and of severe psychological symptoms, contrasting with much fewer referrals to psychological care when language concordance was inadequate. These results suggest the importance of addressing language barriers in primary care centres in order to adequately detect and refer traumatised refugees. To address this problem, the use of professional interpreters is recommended.
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Main CJ, Waddell G. Behavioral responses to examination. A reappraisal of the interpretation of "nonorganic signs". Spine (Phila Pa 1976) 1998; 23:2367-71. [PMID: 9820920 DOI: 10.1097/00007632-199811010-00025] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Waddell et al in 1980 developed a standardized assessment of behavioral responses to examination. The signs were associated with other clinical measures of illness behavior and distress, and are not simply a feature of medicolegal presentations. Despite clear caveats about the interpretation of the signs, they have been misinterpreted and misused both clinically and medicolegally. Behavioral responses to examination provide useful clinical information, but need to be interpreted with care and understanding. Isolated signs should not be overinterpreted. Multiple signs suggest that the patient does not have a straightforward physical problem, but that psychological factors also need to be considered. Some patients may require both physical management of their physical pathology and more careful management of the psychosocial and behavioral aspects of their illness. Behavioral signs should be understood as response affected by fear in the context of recovery from injury and the development of chronic incapacity. They offer only a psychological "yellow-flag" and not a complete psychological assessment. Behavioral signs are not on their own a test of credibility or faking.
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Nagengast SL, Baun MM, Megel M, Leibowitz JM. The effects of the presence of a companion animal on physiological arousal and behavioral distress in children during a physical examination. J Pediatr Nurs 1997; 12:323-30. [PMID: 9420370 DOI: 10.1016/s0882-5963(97)80058-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to examine the effects of the presence of a companion animal on physiological arousal and behavioral distress exhibited by preschool children during a routine physical examination. A within-subject, time-series design was used to study 23 healthy children ages 3 years to 6 years during two physical examinations, with and without a dog. Statistically significant differences were found with greater reductions in subjects' systolic and mean arterial pressure, heart rate, and behavioral distress when the dog was present. Findings support the use of a companion animal in reducing stress experienced by children during a physical examination.
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Clinical Trial |
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Adams CH, Smith NJ, Wilbur DC, Grady KE. The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference? Women Health 1993; 20:45-57. [PMID: 8372479 DOI: 10.1300/j013v20n02_04] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Obese women are at higher risk for the development of both endometrial and ovarian carcinoma. Biochemical mechanisms represent documented causal factors but the role of psycho-social attitudes has received limited attention. This study examined the difference in the frequency of pelvic screening examinations between obese and non-obese women and the effect of physician and patient attitudes toward obesity on examination frequency. A total of 291 women subjects and 1316 physician subjects participated in this study. Data reported in this paper suggest that attitudes and behaviors are negatively influenced by weight. As subjects' weight went up, negative opinions about their appearance and reluctance to obtain pelvic examinations also increased while the likelihood of having annual pelvic examinations decreased. A substantial minority (17%) and an overwhelming majority (83%) of physicians indicated they were reluctant to perform pelvic examinations on obese and reluctant patients respectively. If physicians are more reluctant to perform pelvic examinations on obese and reluctant women and obese women are more reluctant to be examined, there may be a critical delay in detecting adenocarcinomas of the female genital tract.
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Thrall JS, McCloskey L, Ettner SL, Rothman E, Tighe JE, Emans SJ. Confidentiality and adolescents' use of providers for health information and for pelvic examinations. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2000; 154:885-92. [PMID: 10980791 DOI: 10.1001/archpedi.154.9.885] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the relationship between adolescents' perception of the confidentiality of care provided by their regular health care provider and their reported use of this provider for private health information and for pelvic examinations. DESIGN Anonymous, self-report survey. SETTING Thirty-two randomly selected public high schools in Massachusetts. PARTICIPANTS Of 2224 students in systematically selected 9th and 12th grade classrooms, 1715 (50% male) had a regular provider and a checkup within the last year. RESULTS Of teens surveyed, 76% wanted the ability to obtain confidential health care, but only 45% perceived their regular provider to provide this, and only 28% had discussed it explicitly. Logistic regression analyses revealed strong relationships between confidentiality and all outcomes studied. Among adolescents, the likelihood of having discussed sexually transmitted diseases, pregnancy prevention, and/or facts about sex with their provider was greater among teens who received a confidentiality assurance than that for teens who did not (odds ratio [OR] = 2.7; 95% confidence interval [CI], 2.2-3.4). A similar relationship for teens' likelihood of having discussed substance use with the provider was found (OR = 1.8; 95% CI, 1.4-2.3). Among sexually active females, the likelihood of a recent pelvic examination for those who received a confidentiality assurance was greater than for those who did not (OR = 3.3; 95% CI, 2.1-5.5). CONCLUSIONS This study furthers evidence of an important link between teens' perception of confidentiality and use of health care services and information. Because teens' health risks lie largely in potential risks from health-related behaviors, confidentiality in health care may be a critical factor in disclosure and discussion of risky behaviors, and ultimately in appropriate use of health care services. Efforts should be made to increase teens' access to confidential health care sources.
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Abraído-Lanza AF, Chao MT, Gammon MD. Breast and cervical cancer screening among Latinas and non-Latina whites. Am J Public Health 2004; 94:1393-8. [PMID: 15284049 PMCID: PMC1448461 DOI: 10.2105/ajph.94.8.1393] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether Latinas differ from non-Latinas in having undergone recent mammography, clinical breast examination, or Papanicolaou testing, as well as the contribution of sociodemographic and health care variables to screening. METHODS We used data from the 1991 National Health Interview Survey Health Promotion and Disease Prevention supplement. RESULTS Latinas were less likely than non-Latina Whites to have undergone mammography (odds ratio [OR] = 0.71; 95% confidence interval [CI] = 0.57, 0.88), but this difference was attenuated when we controlled for socioeconomic factors (OR = 0.90; 95% CI = 0.70, 1.15). Latinas did not differ from Whites on Papanicolaou tests or clinical breast examinations. Quality of and access to health care predicted screening. CONCLUSIONS Latina ethnicity does not predict breast and cervical cancer screening behavior independent of sociodemographic and structural factors.
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Research Support, U.S. Gov't, P.H.S. |
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Abstract
Three- and 5-year-old children took part in a quasi-medical event in which the child and an adult stranger examined a "sick" teddy bear. Three days and 1 year after the event, children were interviewed in one of three interview conditions; with real items from the event (real props); with toy representations of those items (toy props); or with verbal prompts (no props). After 3 days, both toys and real items facilitated children's reports compared to verbal prompts, but children interviewed with toy props were less accurate than those interviewed with either real items or verbal prompts. After 1 year, the reports of children interviewed with real items remained more accurate than those of children interviewed with toys, although real items did not differentially protect recall from forgetting compared to either toys or verbal prompts. The report of the older children were as accurate at the 1-year delay as at the 3-day delay, whereas the reports of the younger children were particularly susceptible to errors. Correct information was more likely to be repeated across interviews than were errors. New information introduced for the first time after 1 year was highly unreliable for both age groups, whereas that repeated across interviews was highly reliable.
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Hilden M, Sidenius K, Langhoff-Roos J, Wijma B, Schei B. Women's experiences of the gynecologic examination: factors associated with discomfort. Acta Obstet Gynecol Scand 2003; 82:1030-6. [PMID: 14616277 DOI: 10.1034/j.1600-0412.2003.00253.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study was to evaluate how women experience the gynecologic examination and to assess possible factors associated with experiencing discomfort during the gynecologic examination. METHODS Consecutive patients visiting the Department of Obstetrics and Gynecology at Glostrup County Hospital, Denmark, were invited to participate in the study, and received a postal questionnaire that included questions about the index visit, obstetric and gynecologic history and sexual abuse history. The response rate was 80% (n = 798). The degree of discomfort during the gynecologic examination was indicated on a scale from 0 to 10. Experiencing discomfort was defined as a score of 6 or more, based on the 75th percentile. RESULTS Discomfort during the gynecologic examination was strongly associated with a negative emotional contact with the examiner and young age. Additionally, dissatisfaction with present sexual life, a history of sexual abuse and mental health problems such as depression, anxiety and insomnia were significantly associated with discomfort. CONCLUSION The emotional contact between patient and examiner seemed to have great importance when focusing on discomfort during the gynecologic examination. Furthermore, we found that discomfort was associated with a number of factors that are seldom known to the gynecologists, such as sexual abuse history, mental health problems and patients' sexual life. Gynecologists need to focus on the emotional contact and to reevaluate issues for communication before the examination.
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Robohm JS, Buttenheim M. The gynecological care experience of adult survivors of childhood sexual abuse: a preliminary investigation. Women Health 1996; 24:59-75. [PMID: 9046553 DOI: 10.1300/j013v24n03_04] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The gynecological care experiences of 44 adult survivors of childhood sexual abuse and 30 non-abused controls were investigated and compared. On a self-administered survey, survivors rated the gynecological care experience more negatively than the controls, experienced more intensely negative feelings, and reported being more uncomfortable during almost every stage of the gynecological examination than did the controls. Survivors also reported more trauma-like responses during the gynecological examination, including overwhelming emotions, intrusive or unwanted thoughts, memories, body memories, and feelings of detachment from their bodies. Eighty-two percent of the survivors in the sample had never been asked about a history of sexual abuse or assault by a gynecological care provider, despite clear evidence from this study that such information would be relevant to their care. Implications of the study's findings for gynecological care practice and training are explored, and questions for future research are discussed.
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Leblanc VR, Brooks LR, Norman GR. Believing is seeing: the influence of a diagnostic hypothesis on the interpretation of clinical features. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2002; 77:S67-9. [PMID: 12377709 DOI: 10.1097/00001888-200210001-00022] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Prochazka AV, Lundahl K, Pearson W, Oboler SK, Anderson RJ. Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers. ACTA ACUST UNITED AC 2005; 165:1347-52. [PMID: 15983282 DOI: 10.1001/archinte.165.12.1347] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Current evidence does not support an annual screening physical examination for asymptomatic adults, but little is known about primary care provider (PCP) attitudes and practices regarding an annual physical examination. METHODS We conducted a postal survey (32 items) of attitudes and practices regarding the annual physical examination (in asymptomatic patients 18 years or older) of a random sample of PCPs (specializing in internal medicine, family practice, and obstetrics/gynecology) from 3 geographic areas (Boston, Mass; Denver, Colo; and San Diego, Calif). RESULTS Respondents included 783 (47%) of 1679 PCPs. Overall, 430 (65%) of 664 agreed that an annual physical examination is necessary. Three hundred ninety-three (55%) of 712 disagreed with the statement that national organizations do not recommend an annual physical examination, and 641 (88%) of 726 perform such examinations. Most PCPs agreed that an annual physical examination provides time to counsel patients about preventive health services (696/739 [94%]), improves patient-physician relationships (693/737 [94%]), and is desired by most patients (572/737 [78%]). Most also believe that an annual physical examination improves detection of subclinical illness (545/738 [74%]) and is of proven value (461/736 [63%]). Many believed that tests should be part of an annual physical examination, including mammography (44%), a lipid panel (48%), urinalysis (44%), testing of blood glucose level (46%), and complete blood cell count (39%). CONCLUSIONS Despite contrary evidence, most PCPs believe an annual physical examination detects subclinical illness, and many report performing unproven screening laboratory tests. Primary care providers do not appear to accept recommendations that annual physical examinations be abandoned in favor of a more selective approach to preventing health problems.
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Research Support, Non-U.S. Gov't |
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61 |
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Lampic C, Wennberg A, Schill JE, Brodin O, Glimelius B, Sjödén PO. Anxiety and cancer-related worry of cancer patients at routine follow-up visits. Acta Oncol 1994; 33:119-25. [PMID: 8204268 DOI: 10.3109/02841869409098394] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Anxiety and cancer-related worry were assessed in 197 consecutive cancer patients attending follow-up visits. Participants completed questionnaires on three occasions: at the visit, some days later, and three weeks later. Results show that while a majority of patients feel no or only mild anxiety in conjunction to the follow-up visit, about one-fifth report moderate or strong anxiety. Many patients (46%) worry about suffering a recurrence and about overlooking symptoms of new cancer (33%). Patients who were not in complete remission reported higher levels of cancer-related worry concerning the follow-up visit than did patients in remission. Among patients in remission, those who recently terminated treatment reported more overall distress than patients two or more years since treatment termination.
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Brenick A, Romano K, Kegler C, Eaton LA. Understanding the Influence of Stigma and Medical Mistrust on Engagement in Routine Healthcare Among Black Women Who Have Sex with Women. LGBT Health 2017; 4:4-10. [PMID: 28113005 PMCID: PMC5278794 DOI: 10.1089/lgbt.2016.0083] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE For Black women who have sex with women (BWSW), obtaining routine healthcare can be obstructed by a number of psychosocial barriers, including experiences of stigma, related to both sexual orientation and race, and medical mistrust, both race-based and global. Previous research demonstrates that sexual orientation and race-based stigma, as well as global and race-based medical mistrust, each have a negative impact on health outcomes and engagement in care (EIC) independently. This study addresses gaps in the literature by examining the impact of these psychosocial barriers and their interactions among BWSW, an understudied population. METHODS Participants (256 BWSW) were surveyed at a Black Gay Pride festival. Separate generalized linear models assessed the independent and multiplicative effects of participants' self-reported sexual orientation stigma, race-based stigma, race-based medical mistrust, and global medical mistrust related to their engagement in routine physical exams and blood pressure screenings. RESULTS Prevalence rates of both stigma measures were low, but prevalence rates of global and race-based medical mistrust were high. The results show that experiencing sexual orientation stigma or having race-based medical mistrust predicts significantly lower EIC. Furthermore, the frequencies of obtaining recent physical examinations and blood pressure screenings were significantly related to three- and two-way interactions between stigma and medical mistrust, respectively. CONCLUSION There is an urgent need to address the intersectionality of these psychosocial barriers in an effort to increase BWSW's EIC.
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Research Support, N.I.H., Extramural |
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60 |
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Resnick H, Acierno R, Holmes M, Kilpatrick DG, Jager N. Prevention of post-rape psychopathology: preliminary findings of a controlled acute rape treatment study. J Anxiety Disord 1999; 13:359-70. [PMID: 10504107 DOI: 10.1016/s0887-6185(99)00010-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Violent sexual assault such as rape typically results in extremely high levels of acute distress. The intensity of these acute psychological reactions may play a role in later recovery, with higher levels of immediate distress associated with poorer outcome. Unfortunately, post-rape forensic evidence collection procedures may serve to increase, rather than reduce initial distress, potentially exacerbating future psychopathology. To address these concerns, an acute time-frame hospital-based video intervention was developed to: (a) minimize anxiety during forensic rape exams, and (b) prevent post-rape posttraumatic stress disorder (PTSD), panic, and anxiety. Preliminary data indicated that (1) psychological distress at the time of the exam was strongly related to PTSD symptomatology 6 weeks post-rape, and (2) the video intervention successfully reduced distress during forensic exams.
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Clinical Trial |
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Ornstein PA, Baker-Ward L, Gordon BN, Pelphrey KA, Tyler CS, Gramzow E. The influence of prior knowledge and repeated questioning on children's long-term retention of the details of a pediatric examination. Dev Psychol 2006; 42:332-44. [PMID: 16569171 DOI: 10.1037/0012-1649.42.2.332] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Children's recall of the details of pediatric examinations was examined over the course of a 6-month interval. Although the 83 4- to 7-year-old participants reported a substantial amount of information at each assessment, performance declined over time, dropping sharply over the course of 3 months but then remaining constant out to the final interview at 6 months. As expected, older children provided more total information than younger children did and reported a greater proportion of the event components in response to general rather than specific questions. However, comparable patterns of remembering and forgetting over time were observed at each age level. In addition, no effects of repeated questioning--in the form of an interview at 3 months for half of the children--were observed on performance at the 6-month assessment. Moreover, children's prior knowledge about routine doctor visits was assessed before the checkup for half of the participants at each age and was associated with initial but not delayed recall. Although knowledge increased with age as expected, it nonetheless affected recall over and above the influence of age.
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Research Support, N.I.H., Extramural |
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Abstract
OBJECTIVE We aimed to explore women's experiences of pelvic examinations. METHOD A qualitative study was carried out with in-depth interviews based on Kvale's principles, analysis using Giorgi's phenomenological approach, and a feminist frame of reference. Purposeful sampling included 13 women of various ages and backgrounds interviewed after a pelvic examination. The main outcome measures were descriptions and concepts reflecting the most important matters experienced by the women. RESULTS Women are nervous before a pelvic examination, but regard it as a necessary procedure to rule out gynaecological disease. Advance expectations were worse than the actual experience. The women identified several matters as essential for their ability to feel in control during the procedure, such as the doctor's gender, informed communication, positioning during examination, integrity during nakedness, and trust in the doctor. The importance of the different issues varied between women. CONCLUSION Pelvic examination is a procedure which reveals ambivalence in the women due to its intimate relationship between sex, power, and medical knowledge. The doctor can contribute to empowerment of the women by acknowledging the specific context of the procedure, listening to the voice of the individual patient and respecting the inherent ambivalence of the situation.
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Eva KW, Hodges BD. Scylla or Charybdis? Can we navigate between objectification and judgement in assessment? MEDICAL EDUCATION 2012; 46:914-9. [PMID: 22891912 DOI: 10.1111/j.1365-2923.2012.04310.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Lakhani NA, Saraiya M, Thompson TD, King SC, Guy GP. Total body skin examination for skin cancer screening among U.S. adults from 2000 to 2010. Prev Med 2014; 61:75-80. [PMID: 24418263 PMCID: PMC4515307 DOI: 10.1016/j.ypmed.2014.01.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 11/02/2013] [Accepted: 01/02/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Melanoma incidence and mortality are increasing among United States adults. At present, routine skin cancer screening via total body skin examinations (TBSEs) by a physician is not recommended by the United States Preventive Services Task Force (USPSTF); while organizations such as the American Cancer Society recommend screening. Currently, there are limited data on the prevalence, correlates, and trends of TBSE among United States adults. METHODS We analyzed data by race/ethnicity, age, and skin cancer risk level, among other characteristics from three different National Health Interview Survey (NHIS) cancer control supplements conducted every five years since 2000 in random United States households. High-risk status and middle-risk status were defined based on the USPSTF criteria (age, race, sunburn, and family history). RESULTS Prevalence of having at least one TBSE increased from 14.5 in 2000 to 16.5 in 2005 to 19.8 in 2010 (P<0.0001). In 2010, screening rates were higher among the elderly, the fair-skinned, those reporting sunburn(s), and individuals with a family history of skin cancer. Approximately 104.7million (51.1%) U.S. adults are at high-risk for developing melanoma, of which 24.0% had at least one TBSE. CONCLUSIONS TBSE rates have been increasing since 2000 both overall and among higher-risk groups. Data on screening trends could help tailor future prevention strategies.
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research-article |
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Padela AI, Rodriguez del Pozo P. Muslim patients and cross-gender interactions in medicine: an Islamic bioethical perspective. JOURNAL OF MEDICAL ETHICS 2011; 37:40-44. [PMID: 21041237 DOI: 10.1136/jme.2010.037614] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations.
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Mangione-Smith R, Stivers T, Elliott M, McDonald L, Heritage J. Online commentary during the physical examination: a communication tool for avoiding inappropriate antibiotic prescribing? Soc Sci Med 2003; 56:313-20. [PMID: 12473316 DOI: 10.1016/s0277-9536(02)00029-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A previously identified communication behavior, online commentary, is physician talk that describes what he/she is seeing, feeling, or hearing during the physical examination of the patient. The investigators who identified this communication behavior hypothesized that its use may be associated with successful physician resistance to perceived or actual patient expectations for inappropriate antibiotic medication. This paper examines the relationship between actual and perceived parental expectations for antibiotics and physician use of online commentary as well as the relationship between online commentary use and the physician's prescribing decision. We conducted a prospective observational study in two private pediatric practices. Study procedures included a pre-visit parent survey, audiotaping of study consultations, and post-visit surveys of the participating physicians. Ten pediatricians participated (participation rate=77%) and 306 eligible parents participated (participation rate=86%) who were attending sick visits for their children with upper respiratory tract infections between October 1996 and March 1997. The main outcomes measured were the proportion of consultations with online commentary and the proportion of consultations where antibiotics were prescribed. Two primary types of online commentaries were observed: (1) online commentary suggestive of a problematic finding on physical examination that might require antibiotic treatment ('problem' online commentary), e.g., "That cough sounds very chesty"; and (2) online commentary that indicated the physical examination findings were not problematic and antibiotics were probably not necessary ('no problem' online commentary), e.g., "Her throat is only slightly red". For presumed viral cases where the physician thought the parent expected to receive antibiotics, if the physician used at least some 'problem' online commentary, he/she prescribed antibiotics in 91% (10/11) of cases. Conversely, when the physician exclusively employed 'no problem' online commentary, antibiotics were prescribed 27% (4/15) of the time (p = 0.07). Use of 'no problem' online commentary did not add significantly to visit length. 'No problem' online commentary is a communication technique that may provide an effective and efficient method for resisting perceived expectations to prescribe antibiotics.
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Abstract
OBJECTIVE to explore women's experiences during vaginal examinations in labour. DESIGN qualitative with phenomenological approach. Data were collected by tape-recorded open-ended interviews during the early postnatal period. DATA ANALYSIS phenomenological hermeneutic analysis based upon Riceour's interpretation theory. PARTICIPANTS a purposive sample of eight women post-delivery who had given birth vaginally and were able to speak and read Chinese. SETTING a maternity unit of a University affiliated District General Hospital in Hong Kong. KEY FINDINGS women accepted the necessity for vaginal examinations, but expressed the need to be able to trust that the examiner would respect them as individuals and try to maintain their dignity, perform the examination skillfully and communicate the findings to them. Pain and embarrassment were frequently experienced during vaginal examination. Women wanted to be supported during the examination by someone they knew and trusted; they appreciated practitioners who tried to minimise their physical and psychological discomfort. Some women felt embarrassed when examined by a male doctor, but the attitude and approach of the examiner was generally found to be more important than gender. IMPLICATIONS FOR PRACTICE practitioners should be continuously aware of the need to show respect and consideration for the dignity of a woman undergoing vaginal examination in labour. Although this seems an obvious statement to make it is reiterated because some practitioners display insensitivity in this regard. Each woman should be treated with courtesy and respect, and her modesty protected by minimal exposure and examiners/examinations. Findings from the examination should be discussed with her. Practitioners should be aware of the cultural influences that may lead a woman to hide her pain during examination and should be alert for signs of this.
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Carlsson S, Aus G, Wessman C, Hugosson J. Anxiety associated with prostate cancer screening with special reference to men with a positive screening test (elevated PSA) - Results from a prospective, population-based, randomised study. Eur J Cancer 2007; 43:2109-16. [PMID: 17643983 DOI: 10.1016/j.ejca.2007.06.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/05/2007] [Accepted: 06/06/2007] [Indexed: 10/23/2022]
Abstract
Levels of anxiety were assessed through questionnaires completed by 1781 screen-positive (PSA > or = 3 ng/mL) men attending the European Randomised Study of Screening for Prostate Cancer in Gothenburg, Sweden. During the first visit (clinical examination, including biopsies), no anxiety whilst awaiting the PSA test results was reported by 66% and 2% reported high levels of anxiety. A multinomial logistics model for repeated measurements, adjusted for age, PSA level, heredity, biopsy finding and urinary symptoms, revealed that anxiety awaiting the PSA was only influenced (increased) by the existence of previously elevated PSA tests (p<.0001). No anxiety associated with biopsy was reported by 45%, while 6% experienced high levels of anxiety. Levels of anxiety decreased significantly with subsequent rounds of examinations (p<0.0001) and with increasing age (p=0.0016). Anxiety associated with prostate cancer screening in general is low to moderate, even in men with elevated PSA, and severe anxiety affects a smaller group of susceptible men.
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Ybarra GJ, Passman RH, Eisenberg CS. The presence of security blankets or mothers (or both) affects distress during pediatric examinations. J Consult Clin Psychol 2000; 68:322-30. [PMID: 10780133 DOI: 10.1037/0022-006x.68.2.322] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Because of parental interference, some pediatricians prefer examining children without parents nearby. Can inanimate, noninterfering attachment agents placate children during medical evaluations? Accompanied through random assignment by their mother, blanket, mother plus blanket, or no supportive agent, 64 blanket-attached or blanket-nonattached 3-year-olds underwent 4 routine medical procedures. Behavioral and physiological measures showed that mothers and blankets (for children attached to them) equally mitigated distress compared with no supportive agents. However, simultaneously presenting 2 attachment agents did not produce additive soothing effects. For comforting blanket-attached children during moderately upsetting medical procedures, blankets can function as appropriate maternal substitutes. Distress evidenced by children with no attachment agent demonstrates the undesirability of conducting medical examinations without supportive agents.
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