Myofascial pain, widespread pressure hypersensitivity, and hyperalgesia in the face, neck, and shoulder regions, in survivors of head and neck cancer.

PURPOSE: Medical treatment for head and neck cancer may induce the presence of inflammation, pain, and dysfunction. The purpose of the current study was to assess the presence of myofascial trigger points (TrPs) and their relationship with widespread pressure hypersensitivity and hyperalgesia in survivors of head and neck cancer (sHNC). METHODS: TrPs and pressure-pain thresholds (PPTs) were quantified in different muscles/joints in the head and neck of 30 sHNC (59.45 ± 13.13 years) and 28 age- and sex-matched controls (58.11 ± 12.67 years). RESULTS: The sHNC had more TrPs in all muscles on the affected side (p < 0.05) than did the healthy controls, and in the temporalis, masseter, and suboccipitalis muscles on the unaffected side (p < 0.05). They also had lower PPTs in all places (p < 0.05) except for the temporalis muscle (p = 0.114) and C5-C6 joint (p = 0.977). The intensity of cervical pain correlated positively with the presence of upper trapezius TrPs. CONCLUSIONS: sHNC suffering cervical and/or temporomandibular joint pain have multiple active TrPs and experience widespread pressure hypersensitivity and hyperalgesia, suggestive of peripheral and central sensitization.

¿Bienvenido y hasta luego u hola y adiós?: conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas / Welcome and I´ll see you again or hallo and goodbye? Communicative behaviour of medical residents in the first and last moments of a consultation

Objetivos. Describir las conductas empleadas por los residentes en los momentos iniciales (recibimiento, primeros segundos de la obtención de información) y finales de las consultas y valorar en qué medida interrupciones muy precoces de estos a los pacientes afectan a algunos resultados intraconsultas como la duración de los cierres o la aparición de nuevas demandas en esta fase. Diseño. Estudio observacional, descriptivo. Emplazamiento. Consultas de atención primaria. Participantes. Treinta y siete residentes de medicina de familia de tercer año y 307 pacientes con problemas incidentes. Material y método. Todas las consultas fueron videograbadas y analizadas por dos observadores entrenados que usaron protocolos establecidos ad hoc previamente validados. Resultados. Los residentes realizaron recibimientos y cierres de consulta muy breves y comunicativamente muy pobres ya que emplearon muy pocas habilidades relacionales. La mitad de los médicos redirigen muy precozmente el discurso inicial del paciente (en 16 s) y esto se asoció significativamente (p = 0,03) a nuevas demandas del paciente en el momento del cierre y con despedidas más prolongadas (p = 0,001). Conclusiones. La conducta de los residentes en los instantes estudiados seguramente limita su capacidad para establecer y mantener la relación clínica, obtener información y aclarar la que dan a los pacientes. Los cierres disfuncionales son más probables cuando el médico tiene conductas dominantes muy precozmente; estas conductas no acortan las entrevistas

Objectives. To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase. Design. Descriptive observational study. Location. Primary care clinics. Participants. Thirty seven third year residents of family medicine and 307 patients with incidental problems. Material and method. All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures. Results. The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001). Conclusions. The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations

[Welcome and I'll see you again, or hello and goodbye?: Communication behaviour of medical residents at the beginning and the end of consultations]. / Bienvenido y hasta luego u hola y adiós?: Conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas.

OBJECTIVES: To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase. DESIGN: Descriptive observational study. SETTING: Primary care clinics. PARTICIPANTS: Thirty seven third year residents of family medicine and 307 patients with incidental problems. Material and method. All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures. RESULTS: The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001). CONCLUSIONS: The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations.

[Organized consultation by telephone: preliminary results]. / Consulta organizada telefónica: resultados preliminares.

OBJECTIVE: To improve follow-up of health problems, once detected, until their resolution. Also to introduce corrective measures to the demand for Primary Care consultations. DESIGN: Prospective study of Organised Telephone Consultations (OTC). SITE. General Medicine quota of the PC team at Ofra-Delicias (Tenerife). PATIENTS OR OTHERS PARTICIPANTS: A total of 108 procedures were included. MAIN MEASUREMENTS AND RESULTS: The preliminary results, corresponding to the period evaluated (February to June 1991) are presented. The percentage of cases resolved was 78.70%. 83.53% of the cases resolved required only one telephone call. The overall time used for the resolution was equal to or less than 5 minutes in 77.64% of cases and from 5 to 10 minutes in the remainder. CONCLUSIONS: The results, taken overall, were positive, especially with regards to the optimisation of resources.