Patients understanding of terminology commonly used during combined orthodontic-orthognathic treatment

BackgroundCommunication between patients and clinicians plays an important role in improving quality of healthcare and clinical outcomes and ensuring that patients understand medical terminology used by their physicians is a core aspect of this. The aim of this study is to evaluate the degree of patient understanding with respect to commonly used terms in a joint orthodontic-maxillofacial clinic in the context of preparing for combined orthodontic/orthognathic treatment.MethodsPatients were recruited to partake in a short two-part questionnaire. Demographic data collected included participants’ age, sex, level of education, fluency of English and whether English was their first language. In the second part of the questionnaire, participants were asked to identify the correct definition of 11 commonly used terms from a series of multiple-choice answers.Results51 patients participated in this study ranging between ages 15 to 52. 86% of patients selected English as their first language and 37% reported having a university education. The overall mean score for the questionnaire was 44%, with the best understood term being ‘retainers’ at 80% correct and ‘decalcification’ the worst understood at 14% correct. An association between level of education and understanding of specific terms was detected.ConclusionThis study highlights the overall sub-optimal patient understanding of medical terminology used by clinicians on a joint orthodontic-maxillofacial orthognathic clinic. The authors of this study recommend further consideration to the terminology currently used as well as adapting the mode and frequency of information delivery, serving to improve patients’ understanding and retention of medical conversations.     

Patients' understanding of pre-operative fasting

We aimed to assess elective day surgery patients' understanding of the reason for pre-operative fasting. One hundred adult patients presenting to the peri-operative unit for day procedures requiring general anaesthesia were surveyed before discharge. All day-stay, adult patients able to complete a questionnaire in English were included. Only 22% (95%CI [14,31]) of patients correctly understood why fasting was necessary. Patients who did not understand were nearly five times more likely to underrate the importance of compliance (risk ratio 4.65, 95%CI [1.2,18]). Two per cent (95%CI [0.2,7]) of patients reported actual non-compliance, and 4% (95%CI [1,10]) stated they would consider misrepresenting their fasting status if it was inconvenient for them to have their surgery postponed. The results of this study suggest a need to better inform day surgery patients about the reason for pre-operative fasting. A better understanding of the need for pre-operative fasting may lead to improved compliance and patient safety.     

"人性化"医学模式在乳癌临床中的应用

一、乳腺癌手术治疗的历史演变 过去的一百年来,乳腺癌外科手术治疗经历了四大历程。随着科学技术的飞速发展,带动着乳腺外科的不断进步。在手术技术、病理学、生理学和生存质量等不同哲学观点的指导下,乳腺癌的手术方式呈螺旋式的向前演变发展。 1.手术技术观点为主导的乳腺癌治疗 乳腺癌的手术治疗研究真正开始于19世纪中叶。随着麻醉法和防腐法的发明以及止血和输血技术的成功应用于临床,外科手术的禁区被一一打开。1867年,英国的杰出外科医师Charles Moors确立了乳腺癌外科手术原则,他认为乳癌复发是因为     

Patients' misunderstanding of common orthopaedic terminology: the need for clarity

INTRODUCTION

Patients'' understanding of their medical problems is essential to allow them to make competent decisions, comply with treatment and enable recovery. We investigated Patients'' understanding of orthopaedic terms to identify those words surgeons should make the most effort to explain.

METHODS

This questionnaire-based study recruited patients attending the orthopaedic clinics. Qualitative and quantitative data were collected using free text boxes for the Patients'' written definitions and multiple choice questions (MCQs).

RESULTS

A total of 133 patients took part. Of these, 74% identified English as their first language. ‘Broken bone’ was correctly defined by 71% of respondents whereas ‘fractured bone’ was only correctly defined by 33%. ‘Sprain’ was correctly defined by 17% of respondents, with 29% being almost correct, 25% wrong and 29% unsure. In the MCQs, 51% of respondents answered correctly for ‘fracture’, 55% for ‘arthroscopy’, 46% for ‘meniscus’, 35% for ‘tendon’ and 23% for ‘ligament’. ‘Sprained’ caused confusion, with only 11% of patients answering correctly. Speaking English as a second language was a significant predictive factor for patients who had difficulty with definitions. There was no significant variation among different age groups.

CONCLUSIONS

Care should be taken by surgeons when using basic and common orthopaedic terminology in order to avoid misunderstanding. Educating patients in clinic is a routine part of practice.     

Patients' perspectives in high-risk medical decision-making

People faced with making risky treatment decisions in the context of life-threatening illness are typically well-informed about their disease, alternative courses of action, and the odds. But they often need help dealing with the emotional and mental challenges of making high-stakes decisions in unfamiliar areas on an accelerated timetable at a time of personal, existential threat. Reframing the situation can help such individuals transcend ingrained perspectives, freeing them from traditional ways of thinking and, in the process restoring their ability to decide, fostering the courage they so desperately need, and even instilling hope in the darkest of times.     

Survey of terminology used for the intraoperative direction of C-arm fluoroscopy

Background

Orthopedic surgeons depend on the intraoperative use of fluoroscopy to facilitate procedures across all subspecialties. The versatility of the C-arm fluoroscope allows acquisition of nearly any radiographic view. This versatility, however, creates the opportunity for difficulty in communication between surgeon and radiation technologist. Poor communication leads to delays, frustration and increased exposure to ionizing radiation. There is currently no standard terminology employed by surgeons and technologists with regards to direction of the fluoroscope.

Methods

The investigation consisted of a web-based survey in 2 parts. Part 1 was administered to the membership of the Canadian Orthopedic Association, part 2 to the membership of the Canadian Association of Medical Radiation Technologists. The survey consisted of open-ended or multiple-choice questions examining experience with the C-arm fluoroscope and the terminology preferred by both orthopedic surgeons and radiation technologists.

Results

The survey revealed tremendous inconsistency in language used by orthopedic surgeons and radiation technologists. It also revealed that many radiation technologists were inexperienced in operating the fluoroscope.

Conclusion

Adoption of a common language has been demonstrated to increase efficiency in performing defined tasks with the fluoroscope. We offer a potential system to facilitate communication based on current terminology used among Canadian orthopedic surgeons and radiation technologists.     

The structure of the medical and pharmaceutical terminology in the Romanian language

When we analyse diachronically the Romanian medical and pharmaceutical terminology, we can say that it represents a lexical ensemble characterized by heterogeneousness. It has its own dynamics due to the specific character of the terms. New lexical elements have been added permanently in the twentieth century to the corpus of medical terms established in the last century. Another characteristic of the medical terminology in our century is its international tendency. The great number of international words--among which those of Latin, Greek and, more recent, English origin--make it easier to decode the message for the specialists speaking different languages. The great number of words of this type emphasize the scholarly, artificial character of the vocabulary. A well-represented class, from the point of view of its number, are the neologism of Latin-Romantic origin, terms that have been adapted phonetically and morphologically to the system of the Romanian language. The linguistic facts we find in the specialty texts (in the XIX and XX centuries) confirm our belief that, as a whole, the medical terminology is a linguistic field in a continuous process of modeling, and mainly that is open to be renewed.     

Patients' attitude towards the use of a chaperone in breast examination

INTRODUCTION

The aim of this study was to assess the attitude and the preferences of patients towards the use of a chaper one during breast examination.

PATIENTS AND METHODS

A two-part questionnaire was circulated among 204 consecutive new patients, attending both symptomatic breast and screened assessment clinics.

RESULTS

A total of 200 questionnaires were fully completed and returned. Although 104 (52%) patients felt that they did not need a chaperone during breast examination, 65 (33%) preferred to have one. Amongst these 65 patients, the majority (52%) wanted a chaperone in the presence of both a male and female doctor whereas 19 (29%) wanted a chaperone in the presence of a male doctor. When patients were asked which person would be the best chaperone for them, 63 patients (32%) preferred their spouse to act as a chaperone, whereas 57 (29%) preferred a clinic nurse. However, the majority of teenagers and young adults (10–30 years) preferred their parents to act as a chaperone. On asking the reason for preferring a chaperone during breast examination, 69% felt a chaperone helped them to feel more at ease, 28% felt they get more support, 23% get less embarrassed and 10% felt safer. The majority (54%) preferred the nurse to offer a chaperone instead of the doctor (22%). Patients generally said they were comfortable in asking for a chaperone (68%). Overall, 68% of patients considered the offer of a chaperone as a sign of respect and the majority felt the attitude (32%) and gender (20%) of the clinician are the two most important factors influencing the chaperone use. Most patients were of the opinion that the presence of a chaperone does not have a negative effect on the doctor-patient relationship (75%), patient confidentiality (74%) and do not cause embarrassment (68%). Following their assessment in clinic, the patients'' views on the use of a chaperone were not significantly changed.

CONCLUSIONS

There is a wide variety of opinion among patients about the desirability of a chaperone during breast examination. However, the majority consider the offer of a chaperone as a sign of respect and many patients commented that the presence of a chaperone is important for medicolegal protection of both patient and clinician. In recent years, there has been an increasing call from medicolegal societies and medical insurance companies for greater use of chaperones during intimate examinations. We feel that recommendations regarding the use of a chaperone should now be incorporated into the British Association of Surgical Oncology guidelines.     

Remarks on some analgesics used in the pain clinic

The mechanism of action of aspirin as an analgesic is an inhibition of biosynthesis of prostaglandins. Thus the site of action has been believed to be peripheral. However, when aspirin is injected intra- thecally, it produces an analgesic effect. Aspirin has a membrane-stabilizing effect and it is used locally for the treatment of post- herpetic neuralgia. Epidural opioids are frequently used for the management of post-operative pain or cancer pain. Pharmacokinetic studies have shown that delayed respiratory depression results from migration of morphine in the cerebrospinal fluid to the brain. Peak concentrations of morphine near the brain stem occur about 3 hours after lumbar epidural injection, whereas lipophilic opioids such as meperidine, peak concentration occur within 30 to 60 minutes. The clearance from cerebrospinal fluid of lipophilic opioids is more rapid than that of morphine. Besides opioids, alpha 2 receptor agonists such as clonidine also have analgesic action when administered into the epidural space. Somatostatin is one of many neuropeptides found in the spinal cord. It has dual action: a mediation of thermal nociception and a general antinociceptive action. When somatostatin is administered intrathecally or epidurally, it produces analgesic effect and its efficacy appears to be equal to that of morphine.     

Referral prioritization at the specialist breast clinic

Aim: The workload of specialist breast clinics is ever increasing and long waiting time is expected. Clinical guidelines were employed to sort out the priority of consultation. The effectiveness of this system is reviewed. Methods: All referrals seen at the specialist breast clinic from January 2002 to March 2002 were retrospectively studied. The guidelines for allocation to urgent appointment included – (1) urgent referral as determined by referring physician; (2) referral not labelled as urgent but certain ‘high risk’ criteria were present: age more than 50, lump bigger than 3 cm, bloody nipple discharge and physical signs suggestive of malignancy like irregular or fixed breast lump. Routine appointment was given if these criteria were not met. Patients with imaging and cytology results available before specialist consultation were given appointment with reference to the investigation result and excluded from the present analysis. Outcome of the patients in each category was assessed. Results: 165 referrals were analysed and 14 cancers were diagnosed. The mean waiting time for urgent and routine appointments were 2 weeks and 20 weeks, respectively. There were 52 urgent referrals and eight (15.4%) cancers were diagnosed compared to six cancers (5.3%) diagnosed in the 113 non‐urgent referrals. Forty‐two patients among these 113 patients were given urgent appointment due to the presence of high‐risk criteria and as a result, all the six patients with cancers were allocated to urgent appointments. None of the patients given routine appointment had breast cancer diagnosed. Conclusion: It was reassuring that no cancer was diagnosed in patients who had been allocated to routine appointment. In addition to the clinical assessment by the referring physicians, certain ‘high‐risk’ criteria serve as useful guides in assigning the urgency of specialist consultation.     

Guidelines on disposing of medical waste in the dialysis clinic

The term "medical waste" varies from state to state as to its name, definition, and scope of coverage. In this article, we will focus on the process of how a dialysis clinic ensures proper classification, labeling, packaging, tracking, and disposal of medical waste. In addition, we will reference: OSHA regulations (29CFR1910), state specific regulations, DOT regulations (49CFR) and FDA regulations that impact the disposal of medical waste.     

Patients' refusal of surgery strongly impairs breast cancer survival

OBJECTIVE: To compare patient and tumor characteristics and survival between women who refused and women who accepted surgery for breast cancer. SUMMARY BACKGROUND DATA: Surgery represents the central component of curative breast cancer treatment, but some women decide not to undergo surgery. Recent studies on the prognosis of non operated breast cancer are nonexistent. PATIENTS AND METHODS: This study included all 5339 patients aged < 80 years with nonmetastatic breast cancer recorded at the Geneva Cancer Registry between 1975 and 2000. We consulted the clinical files of all nonoperated women to identify those who refused surgery. Patients who refused surgery were compared with those accepting surgery using logistic regression. The effect of refusal of surgery on breast cancer mortality was evaluated by Cox proportional hazards analysis. RESULTS: Seventy patients (1.3%) refused surgery. These women were older, more frequently single, and had larger tumors. Overall, 37 (53%) women had no treatment, 25 (36%) hormone-therapy alone, and 8 (11%) other adjuvant treatments alone or in combination. Five-year specific breast cancer survival of women who refused surgery was lower than that of those who accepted (72%, 95% confidence interval, 60%-84% versus 87%, 95% confidence interval, 86%-88%, respectively). After accounting for other prognostic factors including tumor characteristics and stage, women who refused surgery had a 2.1-fold (95% confidence interval, 1.5-3.1) increased risk to die of breast cancer compared with operated women. CONCLUSIONS: Women who refuse surgery for breast cancer have a strongly impaired survival. This information might help patients who are hesitant toward surgery make a better informed decision.