The communication patterns of internal medicine and family practice physicians

BACKGROUND: Although differences between Internal Medicine (IM) and Family Practice (FP) physicians have been examined in terms of care outcomes and cost, there have been few studies of specialty differences in physician-patient communication. METHODS: In 1995, 277 clinical encounters with 29 full-time, community-based FP physicians and 287 clinical encounters with 30 full-time, community based IM physicians were audiotaped. Communication was evaluated with the Roter Interaction Analysis System to reflect data gathering, patient education and counseling, rapport building, partnership building, verbal dominance, and patient-centeredness. Patient satisfaction was measured with an exit questionnaire. RESULTS: IM clinicians ask more biomedical questions (P =.02). FP clinicians engage in more psychosocial discussion (P =.02) and tend to engage in more emotionally supportive exchanges such as empathy and reassurance (P =.06). Significant interaction effects show differential treatment of patient subgroups by specialty; FP physicians were more verbally dominant with female patients (P <.01) and more patient-centered in their communication style with minority patients (P =.03). Although patient satisfaction was similar for IM and FP, satisfaction was more closely linked to measures of rapport and patient-centeredness for patients of FP physicians than for patients of internists. CONCLUSIONS: The current work adds insight into FP and IM differences in both physician-patient communication and predictors of patient satisfaction.     

Drug record discrepancies in an outpatient electronic medical record: frequency,type, and potential impact on patient care at a hemodialysis center

BACKGROUND: Patients who require hemodialysis take many drugs. Electronic drug records may be discrepant with what patients are actually taking. Record discrepancies are a potential source of drug-related problems. We sought to determine the extent to which drug record discrepancies occur in a hemodialysis population. METHODS: This was a prospective observational study of patients enrolled in a pharmacist clinic at an outpatient hemodialysis center from August-December 2001. Patients participated in monthly drug interviews conducted by a pharmacist, during which patient drug use was determined. Data collected consisted of patient demographics, drug type, and number of drugs. Drug record discrepancies were classified and assigned a potential drug-related problem. Results were compared with the electronic drug record. Patients with documented drug record discrepancies were compared with those patients for whom no discrepancy was identified. RESULTS: Over the 5-month period, 215 drug interviews were conducted in 63 patients. One hundred thirteen drug record discrepancies were identified in 38 patients (60%). Discrepancies (mean +/- SD 1.7 +/- 1.3, range 1-7) were identified during 65 drug interviews (30.2%). Electronic drug records were discrepant by one drug record, two drug records, and more than two drug records 60.0%, 26.2%, and 13.8% of the time, respectively. Drug record discrepancies placed patients at risk for adverse drug events and dosing errors in 49.6% and 34.5%, respectively, of 113 discrepancies. Patient age negatively correlated with the number of drug record discrepancies identified (r = -0.27, p = 0.04). CONCLUSIONS: Drug record discrepancies occur frequently among patients undergoing hemodialysis. Incorporation of a pharmacist into the patient care team may increase the accuracy of the electronic drug record and avert unnecessary drug-related problems.     

Use of a lateral offset short-leg walking cast before high tibial osteotomy

The clinical results after high tibial osteotomy for the treatment of symptomatic varus gonarthrosis are unpredictable. Although preoperative gait analysis has been shown to be useful in predicting successful outcome after high tibial osteotomy, there are no readily available preoperative clinical tests for predicting success. The authors did a study to determine the effects of an offset short-leg walking cast as a potential predictor of clinical success after high tibial osteotomy. Specifically, the authors evaluated the effect of an offset short-leg walking cast on pain relief and changes in the peak external adduction moments in patients with symptomatic varus gonarthrosis indicated for high tibial osteotomy. Nineteen consecutive patients indicated for high tibial osteotomy were enrolled and completed the study. All patients had precast gait analysis to determine baseline parameters. Immediately after gait analysis, a short-leg lateral offset walking cast was applied and worn for 3 days to allow time for adaptation. Gait analysis then was repeated. Western Ontario and McMaster Universities Osteoarthritis Index pain scores were obtained before and after the cast was applied. The cast resulted in a mean reduction in pain of 53%, and a mean reduction in the peak external adduction moment of 36% in the 17 of 19 patients who tolerated the cast. The reduction in pain was correlated with the reduction in the peak adduction moment (r = 0.63). The authors conclude that an offset short-leg walking cast results in pain reduction that correlates with changes in external adduction moments about the knee. Therefore, an offset short-leg walking cast may prove to be an effective tool for predicting patients who ultimately will benefit from valgus high tibial osteotomy.     

Lesser metatarsophalangeal joints: standard MR imaging,MR arthrography,and MR bursography--initial results in 48 cadaveric joints

PURPOSE: To delineate the normal magnetic resonance (MR) imaging anatomy of the lesser metatarsophalangeal (MTP) joints in a cadaveric model and compare the MR arthrographic and MR bursographic findings with the standard MR imaging findings. MATERIALS AND METHODS: T1-weighted spin-echo MR imaging of 48 lesser MTP joints of 12 cadaveric feet was performed. The specimens were subsequently evaluated with MR arthrography, MR bursography, or both examinations. Musculoskeletal radiologists evaluated standard MR images to determine the normal appearances of the joint structures, especially the fibrous capsule, plantar plate, and collateral ligament complex (CLC). Signal intensity, morphology, joint thickness, relationships with adjacent structures, and best plane for analysis were analyzed. The contrast material-enhanced (ie, arthrographic and bursographic) MR imaging findings were compared with the standard MR imaging findings. RESULTS: The coronal plane was best for simultaneous depiction of the fibrous capsule, plantar plate, and collateral ligament complex and for assessment of the relationship between the CLC and the plantar plate. The sagittal plane was best for analysis of the bone attachments of the plantar plate and the transverse plane for evaluation of the CLC attachment sites in the phalanges. MR arthrography enabled identification of the bare areas and recesses of the joints, better delineation of the plantar plate articular surface, and better evaluation of the integrity of the soft-tissue components of the joints. Compared with the other examinations, MR bursography did not help improve these evaluations. CONCLUSION: MR imaging is an excellent examination for delineating the anatomy of the lesser MTP joints. Compared with standard MR imaging, only MR arthrography helps improve visualization of the fibrous capsule, plantar plate, and CLC of the lesser MTP joints.     

Central neurocytoma: case report

The authors report a case of intraventricular tumor. The tumor was initially misdiagnosed as an oligodendroglioma but later proved to be a central neurocytoma. The imaging and histopathological features are reviewed. The immunopositivity allows a diagnosis of neurocytoma. Prognosis is favorable following total surgical resection, with low recurrence rate.     

Comparison of clinical and dynamic knee function in patients with anterior cruciate ligament deficiency

BACKGROUND: Whether passive measures of isokinetic muscle strength deficits and knee laxity are related to the dynamic function of the anterior cruciate ligament-deficient knee remains unclear. HYPOTHESES: Arthrometer measurements are not predictive of peak external knee flexion moment (net quadriceps muscle moment), isokinetic quadriceps muscle strength correlates with peak external knee flexion moment (net quadriceps muscle moment), and isokinetic hamstring muscle strength correlates with peak external knee extension moment (net flexor muscle moment). STUDY DESIGN: Cross-sectional study. METHODS: Gait analysis was used to assess dynamic function during walking, jogging, and stair climbing in 44 subjects with unilateral anterior cruciate ligament deficiency and 44 control subjects. Passive knee laxity and isokinetic quadriceps and hamstring muscle strength were also measured. RESULTS: Arthrometer measurements did not correlate with peak external flexion or extension moments in any of the activities tested or with isokinetic quadriceps or hamstring muscle strength. Test subjects also had a significantly reduced peak external flexion moment during all three jogging activities and stair climbing compared with the control subjects and this was correlated with significantly reduced quadriceps muscle strength. CONCLUSIONS: Absolute knee laxity difference did not correlate with dynamic knee function as assessed by gait analysis and should not be used as a sole predictor for the outcome of treatment. Patients with greater than normal strength in the anterior cruciate ligament-deficient limb performed low- and high-stress activities in a more normal fashion than those with normal or less-than-normal strength.     

Expression profiling of breast cancer cells by differential peptide display

Expression profiling of RNAs or proteins has become a promising means to investigate the heterogeneity of histopathologically defined classes of cancer. Peptides, representing degradation as well as processing products of proteins offer an even closer insight into cell physiology. Peptides are related to the turnover of cellular proteins and are capable to reflect disease-related changes in homoeostasis of the human body. Furthermore, peptides derived from tumor cells are potentially useful markers in the early detection of cancer.In this study, we introduced a method called differential peptide display (DPD) for separating, detecting, and identifying native peptides derived from whole cell extracts. This method is a highly standardized procedure, combining the power of reversed-phase chromatography with mass spectrometry. This technology is suitable to analyze cell lines, various tissue types and human body fluids. Peptide-based profiling of normal human mammary epithelial cells (HMEC) and the breast cancer cell line MCF-7 revealed complex peptide patterns comprising of up to 2300 peptides. Most of these peptides were common to both cell lines whereas about 8% differed in their abundance. Several of the differentially expressed peptides were identified as fragments of known proteins such as intermediate filament proteins, thymosins or Cathepsin D. Comparing cell lines with native tumors, overlapping peptide patterns were found between HMEC and a phylloides tumor (CP) on the one hand and MCF-7 cells and tissue from a invasive ductal carcinoma (DC) on the other hand.