Moving beyond the language barrier: The communication strategies used by international medical graduates in intercultural medical encounters

Objective

To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers.

Methods

In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful.

Results

International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication.

Practice implications

Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine.     

Acquired Convergence Substitution in Horizontal Gaze Palsy and Progressive Scoliosis Associated with ROBO3 Mutations

Two female (aged 12 and 14 years) patients with horizontal gaze palsy and progressive scoliosis (HGPPS) from two different Turkish families were evaluated through ophthalmic, neurological, radiological, and orthopaedic examinations. Each proband had one affected sibling with HGPPS. Both patients had absence of horizontal eye movements and simultaneous adduction of both eyes on attempted horizontal gaze associated with miosis. One proband was observed to have this finding at age 9, which had not been present at 5 years old. Neuroradiological imaging revealed brainstem hypoplasia (split pons sign) and scoliosis. The two index patients harboured different homozygous mutations that were heterozygous in the parents, who are obligate carriers. The emergence of convergence and presence of miosis during lateral gaze suggests that simultaneous adduction occurs as a result of the convergence substitution phenomenon. Substituted convergence in cases with HGPPS may occur with different mechanisms than substituted convergence in cases with pontine lesions.     

Up-regulation of calcitonin gene-related peptide and receptor tyrosine kinase TrkB in rat bladder afferent neurons following TNBS colitis

Colonic inflammation has profound effects on the urinary bladder physiology and produces hypersensitivity of bladder afferent neurons and neurogenic bladder overactivity. Calcitonin gene-related peptide (CGRP) expressed in dorsal root ganglia (DRG) plays an important role in mediating sensory perception following visceral inflammation. In the present study, we determined that the expression of CGRP was increased in bladder afferent neurons in lumbosacral DRG following tri-nitrobenzene sulfonic acid (TNBS)-induced colitis in rat. After colitis, the percentage of bladder afferent neurons expressing CGRP was increased in L1 (61.2+/-2.9% in colitis vs. 37.7+/-5.1% in controls; p<0.05) and S1 DRG (26.3+/-2.3% in colitis vs. 15.5+/-1.9% in controls; p<0.01). We also demonstrated that the expression of tyrosine kinase receptor TrkB was increased in L1 (39.7+/-2.9% in colitis vs. 25.2+/-4.3% in controls; p<0.05) and S1 DRG (45.6+/-3.8% in colitis vs. 38.3+/-3.6% in controls; p<0.01) following colitis. CGRP and TrkB were co-stored in a subpopulation of DRG neurons in control and colitic animals and the number of DRG cells co-expressing CGRP and TrkB was significantly increased in L1 (2.7-fold, p<0.01) and S1 DRG (2.4-fold, p<0.01) following colitis. In cultured DRG, exogenous BDNF application significantly increased CGRP expression, which was blocked by TrkB selective inhibitor K252a. These results suggest that up-regulation of CGRP and TrkB in bladder afferent neurons may play a role in colon-to-bladder cross-sensitization following colitis.     

Vision in Children and Adolescents with Autistic Spectrum Disorder: Evidence for Reduced Convergence

Evidence of atypical perception in individuals with ASD is mainly based on self report, parental questionnaires or psychophysical/cognitive paradigms. There have been relatively few attempts to establish whether binocular vision is enhanced, intact or abnormal in those with ASD. To address this, we screened visual function in 51 individuals with autistic spectrum disorder and 44 typically developing individuals by measuring visual acuity, stereoacuity, convergence, divergence, ocular motility, incidence of strabismus and integrity of the optokinetic response. The data suggest that many aspects of vision, including visual acuity, are unaffected in ASD, but that convergence is an aspect of visual function that merits further research in those with ASD.

发散与收敛中药干预急性荨麻疹的临床量化指标与阴阳学说符合度探讨

目的 根据中医阴阳学说基本理论,急性期荨麻疹应选用发散药,而非收敛药.为证明中医理论的科学性,我们开展了实验组(发散中药)与对照组(收敛中药)和仪器质控标准品“媒比”(MEBE)双重对照急性期荨麻疹患者可量化、可重复性中药筛选试验.方法 采用德国MORA-Super生物共振治疗仪(药物筛选程序)作为检测指标,选择32例急性期荨麻疹志愿者,开展发散与收敛中药筛选试验,以观察其结果是否符合阴阳学说的基本理论(即急性期荨麻疹应选出发散中药).结果 通过32例急性期荨麻疹患者重复试验,试验组(23)种发散药中筛选出22种;对照组(12)种收敛药中筛选出(0)种,符合阴阳对立的基本理论,其中,排在前5位的发散药分别为防风、蝉蜕、荆芥、蔓荆子、辛夷.结论 急性荨麻疹选用发散类中药符合中医基本理论.     

不同瓜蒌子饮片的成分比较

新世纪伊始 ,扩招后的医学生进入临床 ,实习学生迅速增加 ,并且医院还面临着激烈的行业竞争、医疗任务繁重 ,导致学生的实习积极性下降 ,质量下滑。我们以实习集中教学活动为关键 ,加以规范化管理后 ,学生的实习质量有了较大的提高。本文分析了临床实习集中教学活动的概念、特点 ,并就我们在改革中的做法、效果展开讨论。     

The reliability of an easy measuring method for abutment convergence angle with a computer-aided design (CAD) system

PURPOSE

The purpose of this study was to evaluate the intra-rater reliability and inter-rater reliability of three different methods using a drawing protractor, a digital protractor after tracing, and a CAD system.

MATERIALS AND METHODS

Twenty-four artificial abutments that had been prepared by dental students were used in this study. Three dental students measured the convergence angles by each method three times. Bland-Altman plots were applied to examine the overall reliability by comparing the traditional tracing method with a new method using the CAD system. Intraclass Correlation Coefficients (ICC) evaluated intra-rater reliability and inter-rater reliability.

RESULTS

All three methods exhibited high intra-rater and inter-rater reliability (ICC>0.80, P<.05). Measurements with the CAD system showed the highest intra-rater reliability. In addition, it showed improved inter-rater reliability compared with the traditional tracing methods.

CONCLUSION

Based on the results of this study, the CAD system may be an easy and reliable tool for measuring the abutment convergence angle.     

The effect of preparation taper on the resistance to fracture of monolithic zirconia crowns

ObjectiveMonolithic zirconia crowns have become a viable alternative to conventional layered restorations. The aim of this study was to evaluate whether the taper, and thus wall thickness, of the abutment or pre-defined cement space affect the fracture resistance or fracture mode of monolithic zirconia crowns.MethodsA model tooth was prepared with a taper of 15° and a shallow circumferential chamfer preparation (0.5 mm). Two additional models were made based on the master model with a taper of 10° and 30° using computer-aided design software. Twenty monolithic 3rd generation translucent zirconia crowns were produced for each model with pre-defined cement space set to either 30 μm or 60 μm (n = 60). The estimated cement thickness was assessed by the replica method. The cemented crowns were loaded centrally in the occlusal fossa at 0.5 mm/min until fracture. Fractographic analyses were performed on all fractured crowns.ResultsThe load at fracture was statistically significant different between the groups (p < 0.05). The crowns with 30° taper fractured at lower loads than those with 10° and 15° taper, regardless of the cement space (p < 0.05). The fracture origin for 47/60 crowns (78%) was in the cervical area, close to the top of the curvature in the mesial or distal crown margin. The remaining fractures started at the internal surface of the occlusal area and propagated cervically.SignificanceThe fracture resistance of the monolithic zirconia crowns was lower for crowns with very large taper compared to 10 and 15° taper even though the crown walls were thicker.     

Convergence of olfactory and nasotrigeminal inputs and possible trigeminal contributions to olfactory responses in the rat thalamus

Summary To elucidate the role of trigeminal input on the olfactory system, field-evoked potentials were measured following electrical stimulation of the nasociliary branch of the trigeminal nerve in the olfactory-related structures in the rat brain. Significant potential changes were recorded in the mediodorsal nucleus of the thalamus and the lateral hypothalamic area. In the mediodorsal nucleus of the thalamus, the neurons responding to olfactory bulb electrical stimulation also responded to trigeminal nerve stimulation. Single neuronal responses of mediodorsal thalamic neurons following odorant stimulation were enhanced by blockade of the trigeminal nerve with procaine. These results suggest that olfactory and trigeminal pathways converge on the same neural elements within the mediodorsal nucleus of the thalamus and that the trigeminal input may modulate olfactory input in this nucleus.Correspondence to: A. Inokuchi     

苗青教授补、宣、敛并用治疗间质性肺病相关咳嗽的经验

慢性、顽固性咳嗽是间质性肺病最常见的临床症状,咳嗽亦是间质性肺病进展的独立预测因子,但目前相关机理研究缺乏,能够有效缓解间质性肺病相关咳嗽的药物有待研发.苗青教授结合多年临床经验,认为肺肾气虚、气失敛降、肺气上逆是间质性肺病相关咳嗽的重要病机,因而提出补益肺肾、敛肺降气、宣肺止咳法,并取得了较好疗效.