RESUMEN
Patient satisfaction is important to patient outcomes. Previous attempts to conceptualize satisfaction have often taken an atheoretical approach and focused on doctors' communication skills. Patients are becoming more active health consumers involved in their health care and current definitions of patient satisfaction may not accurately reflect patient expectations about their health consultations. Earlier research found that meeting patients' emotional needs - through empathy and patient-centered communication - is important to patient satisfaction. New research is needed to explore how those needs can be met given the changing trend in patient behaviors and the focus on patient-centredness. This study employed two communication theories - the Willingness to Communicate Model and Communication Accommodation Theory - to consider both patients' communicative decisions, and the intergroup features of the health context that can influence communicative behaviors. Two hundred and fifty-three patients from health clinics in Canada and Australia described what satisfaction meant to them, and identified what aspects of their health consultation were satisfying (or not), and we investigated their perceptions of doctor's emotional expression. Results suggest that patient perceptions of their participation in the consultation predicts their perceptions of doctor emotional expression, and their satisfaction with the consultation. Patients want both emotional and medical needs met in an environment that balances interpersonal and intergroup communication. Our findings suggest the need to expand current definitions of patient satisfaction, patient-centredness and emotional expression. We discuss the implications of these findings for health practitioners and consider future research that addresses the need for more individualized health care.
Asunto(s)
Satisfacción Personal , Relaciones Médico-Paciente , Comunicación , Humanos , Participación del Paciente , Satisfacción del Paciente , PercepciónRESUMEN
Aspirin should not be used to treat acute febrile viral illness in children. (Strength of Recommendation [SOR]: C, based on case-control studies). Although no causal link has been proven, data from case-control and historic cohort studies demonstrate an association between aspirin use and Reye syndrome. The risk of Reye syndrome decreases with age, becoming extremely rare by the late teenage years. Other nonsteroidal anti-inflammatory drugs are effective antipyretics and are not associated with the constellation of symptoms seen in Reye syndrome, which includes nausea, vomiting, headache, excitability, delirium, combativeness, and coma. Aspirin use in children younger than 19 years should be limited to diseases in which aspirin has a proven benefit, such as Kawasaki disease and the juvenile arthritides. (SOR: C, based on expert opinion).
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Aspirina/efectos adversos , Fiebre/tratamiento farmacológico , Síndrome de Reye/inducido químicamente , Adolescente , Factores de Edad , Niño , Preescolar , Humanos , Lactante , Guías de Práctica Clínica como Asunto , Factores de RiesgoAsunto(s)
Compuestos de Aluminio/administración & dosificación , Toxinas Botulínicas Tipo A/administración & dosificación , Cloruros/administración & dosificación , Hiperhidrosis/terapia , Iontoforesis/métodos , Administración Tópica , Cloruro de Aluminio , Humanos , Inyecciones , Resultado del TratamientoAsunto(s)
Antidepresivos/uso terapéutico , Depresión/complicaciones , Depresión/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológico , Amitriptilina/uso terapéutico , Antidepresivos Tricíclicos/uso terapéutico , Relación Dosis-Respuesta a Droga , Doxepina/uso terapéutico , Medicina Basada en la Evidencia , Humanos , Mianserina/análogos & derivados , Mianserina/uso terapéutico , Mirtazapina , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trazodona/uso terapéutico , Trimipramina/uso terapéuticoRESUMEN
Inhaled short-acting beta-agonists (SABAs) are most effective in preventing exercise-induced bronchoconstriction, followed by inhaled mast cell stabilizers and anticholinergic agents (strength of recommendation [SOR]: A, multiple randomized control trials [RCTs]). Less evidence supports the use of leukotriene antagonists and inhaled corticosteroids, either individually or in combination (SOR: B). Underlying asthma, which commonly contributes to exercise-induced bronchoconstriction, should be diagnosed and controlled first (SOR: C).
Asunto(s)
Agonistas Adrenérgicos beta/uso terapéutico , Asma/prevención & control , Asma/etiología , Niño , Antagonistas Colinérgicos/uso terapéutico , Ejercicio Físico , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Mastocitos/efectos de los fármacosRESUMEN
Prior bacille Calmette-Guerin (BCG) vaccination increases the likelihood of a positive tuberculosis (TB) 5TU purified protein derivative (PPD) skin test. The PPD response following BCG vaccine varies with age at vaccination, number of years since the BCG vaccination, number of times vaccinated, and number of PPDs performed. An induration of greater than 14 mm is unlikely to be due to prior BCG vaccination (strength of recommendation [SOR]: A, based on meta-analysis of validation cohort studies). The variable reaction after BCG vaccination, along with the desire to detect all cases of TB, has led to recommendations that all patients with a positive PPD test be treated as true positives. These patients should undergo chest radiography and appropriate treatment, regardless of history of BCG vaccine (SOR: B, extrapolation from level 1 study). A recently developed alternative is the interferon-gamma assay (QuantiFERON-TB Gold test), which may be used in place of, or in addition to, the PPD skin test for patients who are known to have received a BCG vaccine (SOR: B, extrapolation from a validation cohort study).
Asunto(s)
Vacuna BCG/administración & dosificación , Tuberculina , Tuberculosis/prevención & control , Estudios de Cohortes , Medicina Basada en la Evidencia , Humanos , Inmunización Secundaria , Sensibilidad y Especificidad , Prueba de Tuberculina/estadística & datos numéricos , Tuberculosis/diagnóstico , Tuberculosis/epidemiologíaRESUMEN
The evaluation of a suspected rotator cuff tear should start with a history and a clinical exam of the shoulder (strength of recommendation [SOR]: B, based on a systematic review of cohort studies). Three clinical test results in particular--supraspinatus weakness, weakness of external rotation, and impingement--or 2 positive tests for a patient older than 60 years were highly predictive of rotator cuff tear (SOR: B, based on individual prospective study). Either magnetic resonance imaging (MRI) or ultrasound can confirm a possible full-thickness tear (SOR: B, based on a systematic review of cohort studies). If a patient has an implantable device prohibiting MRI imaging, conventional arthrography is an alternative (SOR: A, individual randomized controlled trial). Suspected partial-thickness tears are best verified with an ultrasound (SOR: B, based on a systematic review of cohort studies).
Asunto(s)
Lesiones del Manguito de los Rotadores , Traumatismos de los Tendones/diagnóstico , Humanos , Imagen por Resonancia Magnética , Examen Físico , Valor Predictivo de las Pruebas , UltrasonografíaRESUMEN
Infants and toddlers with suspected iron-deficiency anemia should begin treatment with oral ferrous sulfate (3 mg/kg/d of elemental iron). A rise in hemoglobin >1 g/dL after 4 weeks supports the diagnosis of iron deficiency, and supplementation should continue for 2 additional months to replenish iron stores. Recheck hemoglobin at the end of treatment and again 6 months later (strength of recommendation [SOR]: C, based on expert opinion). For primary prevention, counsel parents on the use of iron-fortified formula for non-breastfed infants until the age 12 months (SOR: B, based on randomized controlled study), and introduce iron-rich foods between 4 and 6 months to breastfed babies (SOR: C, based on expert opinion).
Asunto(s)
Anemia Ferropénica/tratamiento farmacológico , Compuestos Ferrosos/uso terapéutico , Administración Oral , Anemia Ferropénica/diagnóstico , Anemia Ferropénica/prevención & control , Recuento de Células Sanguíneas , Preescolar , Hemoglobinas/análisis , Humanos , LactanteAsunto(s)
Quemadura Solar/prevención & control , Protectores Solares/uso terapéutico , Niño , Preescolar , Medicina Basada en la Evidencia , Humanos , Lactante , Nevo Pigmentado/inducido químicamente , Ropa de Protección , Neoplasias Cutáneas/prevención & control , Protectores Solares/efectos adversosAsunto(s)
Enfermedad de Raynaud/diagnóstico , Enfermedad de Raynaud/terapia , Antagonistas Adrenérgicos alfa/uso terapéutico , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Nifedipino/uso terapéutico , Guías de Práctica Clínica como Asunto , Prazosina/uso terapéutico , Vasodilatadores/uso terapéuticoAsunto(s)
Prueba de Papanicolaou , Complicaciones Neoplásicas del Embarazo/patología , Neoplasias del Cuello Uterino/patología , Frotis Vaginal/instrumentación , Seguridad de Equipos , Medicina Basada en la Evidencia , Femenino , Humanos , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Sensibilidad y Especificidad , Frotis Vaginal/métodosRESUMEN
Standard management is best: start with unfractionated heparin or low-molecular-weight heparin and follow with long-term therapy with a vitamin K antagonist. Some evidence supports thrombolytic therapy, placement of a superior vena cava filter, or surgical thrombectomy in selected patients. Whether to remove venous catheters during initial treatment for catheter-induced venous thrombosis remains unclear, because limited studies address this issue specifically.
Asunto(s)
Brazo/irrigación sanguínea , Trombosis de la Vena/terapia , Anticoagulantes/uso terapéutico , Medicina Basada en la Evidencia , Heparina/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Trombectomía , Terapia Trombolítica/métodos , Filtros de Vena Cava , Trombosis de la Vena/etiología , Warfarina/uso terapéuticoRESUMEN
Patients should be placed on the following medications: antiplatelet agents, (meta-analysis for aspirin, multiple randomized controlled trials [RCTs] for aspirin plus clopidogrel); a statin; atorvastatin has the best evidence (a single RCT); a beta-blocker (meta-analysis); renin-angiotensin-aldosterone system blockers, whether or not the ejection fraction is diminished after myocardial infarction (MI) (SOR: A, meta-analysis for angiotensin-converting enzyme [ACE] inhibitor; B, single RCT for ACE inhibitor plus aldosterone blocker).
Asunto(s)
Infarto del Miocardio/tratamiento farmacológico , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Aspirina/administración & dosificación , Atorvastatina , Clopidogrel , Eplerenona , Ácidos Heptanoicos/administración & dosificación , Humanos , Infarto del Miocardio/mortalidad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Pirroles/administración & dosificación , Espironolactona/administración & dosificación , Espironolactona/análogos & derivados , Ticlopidina/administración & dosificación , Ticlopidina/análogos & derivadosAsunto(s)
Antipruriginosos/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Prurito/tratamiento farmacológico , Urticaria/tratamiento farmacológico , Adulto , Niño , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
EVIDENCE-BASED ANSWER: A high-fiber diet may help; available evidence does not support other interventions. A high-fiber diet is often prescribed after recovery from acute diverticulitis, based on extrapolation from epidemiologic data showing an association between low-fiber diets and diverticulosis. No direct evidence establishes a role for fiber in preventing recurrent diverticulitis, however. No evidence supports the common advice to avoid nuts and seeds to prevent diverticulitis. Eating nuts, corn, and popcorn does not increase the risk; in fact, nuts and popcorn may have a protective effect. There is not enough evidence to recommend the anti-inflammatory drug mesalamine or a polybacterial lysate for immunostimulation. Retrospective data do not support routine prophylactic colectomy after 1 or 2 episodes of acute diverticulitis.