Patient-Centredness in the Consultation. 1: A Method for Measurement

Henbest R J and Stewart M A. Patient-centredness in the consultation.1: A method for measurement. Family Practice 1989; 6: 249–254. This paper presents a method for assessing the doctor-patientinteraction in terms of its patientcentredness. Patient-centrednesswas defined in terms of doctor responses which enabled patientsto express all of their reasons for coming, including symptoms,thoughts, feelings and expectations. The method was tested andfound to be valid (correlations for criterion validity rs =0.51 and 0.89), reliable (inter-rater correlation rs = 0.91,intra-rater correlation rs = 0.88), and sensitive, in that itwas able to detect differences among doctors (P < 0.001)and among doctor responses to different patient offers (P<0.001). The method was also found to be practical in that itwas inexpensive and could be used for a variety of purposessuch as by tutors to give feedback to their students, by examinersas part of the evaluation of candidates' consultation skills,and by students and clinicians alike, for self-assessment. Thefinding that the score for the first two minutes of the consultationcorrelated highly with the score for the entire consultation(rs = 0.806) greatly increases the time effectiveness of themethod, suggesting that it would be practical for use on a largescale, including student assessment and future studies of therelationship between patient-centredness and patient outcomes.     

Preoperative Saphenous Vein Mapping for Coronary Artery Bypass

Saphenous vein mapping by real-time duplex ultrasound scanning allows for the confirmation of the presence of patent vein and determination of the anatomical course of the vein prior to aortocoronary bypass procedures. This technique has proven to be of value in patients whose veins are not evident by physical examination and in those whose length of conduit may be limited by previous vein stripping or thrombophlebitis.     

Analysis of the Body Surface ECG Measured in Independent Leads During Ventricular Fibrillation in Humans

The degree of myocardial electrical organization during ventricular fibrillation remains unknown. The aim of this study was to compare the characteristics of the surface ECG on three independent and approximately orthogonal leads. Ten recordings of ventricular fibrillation. each induced at electrophysiology study and successfully terminated by direct current shock, were analyzed. Each recording was divided into 1-second epochs for analysis. Frequency analysis using the Fast Fourier Transform showed that the frequency of the dominant spectral peak increased significantly from a mean of 4.1 ±0.8 Hz to 5.2±0.7 Hz during the first 5 seconds of ventricular fibrillation. In 95% of the epochs analyzed, a similar dominant frequency was observed on either two or three ECG leads. Frequency agreement tended to increase as ventricular fibrillation evolved. This study shows that the rate of ventricular fibrillation increases rapidly during the first 5 seconds but only gradually thereafter, and that similar signal characteristics are observed on independent ECG leads. These findings are not compatible with the traditional view of incoherent myocardial activity during ventricular fibrillation.     

Histological evaluation of microfilled and conventional composite resins on monkey dental pulps

Summary. The pulpal responses to two micro-filled composite resins and a conventional composite resin were investigated in adult rhesus monkey teeth. All materials were randomly placed in unetched and unlined class V buccal cavity preparations. A total of 90 teeth were used in the study. Each material was evaluated at 3 days, 5 weeks and 8 weeks. Following perfusion, the teeth were prepared using routine histological procedures. The results indicated that the pulpal response to the microfilled and conventional composite resins were similar for all time periods, characterized by an initial slight to moderate response at 3 days, followed at 5 and 8 weeks by a zero to slight response with evidence of reparative dentine formation. Brown and Brenn staining for bacteria indicated positive staining reactions along the cavity wails of all teeth for all materials at each time period.     

Issues in Esthetic Dentistry for Older Adults

Abstract: Esthetic dentistry offers a myriad of opportunities for older adults wishing to improve their smile, oral function, and self-esteem. The challenge for dental professionals is to maintain oral health throughout the patient's lifetime, even through periods of dependence that may include residence in a nursing home. Dental professionals will have increasing opportunities to share their knowledge and expertise about the relation between oral health and overall health, with a variety of health professionals who care for the aging population.     

Enantioselective synthesis of (R)- and (S)-2-methyl-[3,3,2-2H3] alanines

The synthesis of optically pure (R)- and (S)-2-methyl-[3,3,3-²H₃] alanines of biological interest is described. The stereochemistry of the reaction of the lithio derivative of (R)-(©)-2,5-dimethoxy-3-benzyl-3-methyl-3, 6-dihydropyrazine with alkyl and deuterated alkyl iodides is discussed. The configuration of the newly formed center of chirality in (R)- and (S)-2-methyl-[3,3,3-²H₃] alanines is derived from ¹ H NMR.     

The Measurement of Opiate Dependence

The application of a dimensional concept of dependence which has received much attention over recent years in relation to alcohol, is explored here in relation to opiate dependence. A Severity of Opiate Dependence Questionnaire (SODQ) was completed by 98 subjects attending a New York drug treatment clinic. The factor structure of this questionnaire was explored and a strong first factor (39% of variance) identified which loaded on items conceptually related to a dimensional opiate dependence syndrome. Some preliminary investigation was made of issues relating to validity: SODQ correlated significantly with ‘number affixes a day’ and with a subjective measure of dependence (OSDQ), but not with quantity of heroin used or milestones in drug career. Research leads are discussed.     

Beat-to-Beat Repolarization Lability Identifies Patients at Risk for Sudden Cardiac Death

QT Interval Variability and Sudden Death. Introduction : Recent studies have implicated repolarization lability in the genesis of malignant ventricular arrhythmias. However, few data exist on assessment of temporal QT interval variability and its relation to arrhythmogenesis. We tested the ability of the QT variability index (QTVI), a measure of beat-to-beat QT interval fluctuations measured on a single ECG lead, to identify patients presenting with malignant ventricular arrhythmias and predict their subsequent occurrences.
Methods and Results : We measured the QTVI in 95 patients presenting for electrophysiologic study (EPS). The ability of the QTVI to identify patients with sudden cardiac death (SCD) or sustained monomorphic ventricular tachycardia (MVT) on presentation and during follow-up of 23.7 ± 14.3 months was compared with spatial QT dispersion, T wave alternans ratio during atrial pacing, MVT inducibility at EPS, signal-averaged ECG, heart rate variability, and ejection fraction. The QTVI was higher in patients with heart disease than in controls (-0.7 ± 0.7 vs −1.1 ± 0.5, P < 0.05), and higher in patients presenting with SCD than in other patients with heart disease (0.0 ± 0.6 vs −0.8 ± 0.5, P < 0.05). The QTVI was the only clinical variable that identified patients who presented with SCD ( P = 0.004, odds ratio = 12.5) on stepwise, logistic multiple regression. Fourteen patients had arrhythmic events during follow-up. In a Kaplan-Meier analysis of arrhythmic events, QTVI ≥ 0.1 was a discriminator for higher risk of arrhythmic events ( P < 0.05).
Conclusions : (1) This noninvasive measure of temporal repolarization lability identified patients with SCD and predicted arrhythmia-free survival. (2) Further studies are needed to determine the mechanisms that mediate beat-to-beat QT interval variability.