Improved health outcomes in integrative medicine visits may reflect differences in physician and patient behaviors compared to standard medical visits

ObjectiveTo identify differences in patient-physician interactions associated with improvements in GERD symptoms in a randomized controlled trial comparing integrative medicine and primary care/standard visits.MethodsWe analyzed video recordings of 2-minute excerpts (thin slices) from the beginning, middle, and end of 21 study visits (11 standard, 10 integrative medicine).ResultsAccording to blind coders’ analysis of the excerpts, prospective improvement in GERD symptoms was most highly correlated with patients appearing pleased (r = 0.71, p < 0.01) and friendly (r = 0.67, p < 0.01) at the end of the visit, controlling for visit type. The combination of patient and physician smiling at the end of the visit was associated with improvement in GERD symptoms (r² = 0.45, p = 0.004). The physician in the integrative visits was more engaged (p = 0.009), friendly (p = 0.005), relaxed (p = 0.002), smiled longer (p = 0.006), gazed longer (p = 0.02), and gestured more (p = 0.007), compared to standard visits. Patients in integrative visits also smiled longer (p = 0.004).ConclusionThe expanded history-taking questions asked by integrative clinicians may enhance relationship building, modifying patients’ responses and improving patient-centered behaviors from clinicians,ultimately facilitating symptom improvement.Practice ImplicationsAnalysis of nonverbal behaviors may facilitate a better understanding of patient-clinician interactions in integrative medicine visits and yield insights to improve clinical interactions in conventional medicine.     

Tocilizumab en paciente con gota tofácea severa refractaria al tratamiento

Gout is a disease characterized by acute episodes of pain, which occurs as the result of monosodic urate crystal deposit in the joint and periarticular tissue. In some cases, gout behaves as a severe inflammatory arthopathy that is difficult to manage, generating structural joint damage and functional impairment. We report the case of a 44 years old man with gouty arthritis for 12 years, not responding to NSAIDs, alopurinol, colchicine or corticosteroids. Tocilizumab was started with favorable clinical and laboratory results after treatment.     

Acoustic characteristics of trill productions by groups of Spanish children

Contrary to the English /r/, which has been extensively analysed, there is very little information on the trilled consonants in Spanish. These sounds are in general difficult to produce for young Spanish children and occur later (than other consonant sounds) in normal development. This paper describes acoustic measurements made on the trill productions in Spanish children with varying degrees of speech intelligibility. The spectral (frequency, amplitude, C-V ratio) and temporal characteristics (duration of the trill, number of open and closed periods?apertures and occlusions-and duration of these periods) were studied in 45 children (Granada, Spain) between 3.0 and 9.6 years old, divided into 5 groups. The results reveal differences in spectral and temporal acoustic correlates of trill /r/ among the five speaker groups (e.g., the duration of the first aperture period was longer for the articulatory disordered group than for the normal control group). They seem to indicate, in particular, that children who have trouble learning to make the trill sound do little more than tap the alveolar ridge. Moreover, these children seem to use more of their tongues to make these gestures; also, they do not make many trills or make them very quickly.