Au-delà de l'ennui: l'effort pour rendre l'autre intéressant [Beyond boredom: the effort to make a patient interesting]

The doctors' emotional reaction towards the patients has an impact on the doctor-patient relationship. This article focuses on a particular emotion, boredom which is evoked by certain patients. By means of a case vignette, this phenomenon is elucidated and confronted with the psycho-analytical concept of "pensée opératoire", and ways are identified to raise the interest in patients.

Specificities of defense mechanisms in bipolar affective disorder: relations with symptoms and therapeutic alliance.

Defense mechanisms as a central notion of psychoanalysis have inspired various levels of interest in research in psychotherapy and psychopathology. Defense specificities have only recently been investigated systematically with regard to several clinical diagnoses, such as affective and personality disorders. For the present study, 30 inpatients diagnosed with Bipolar Affective Disorder I (BD) were interviewed. An observer-rater method, the Defense Mechanisms Rating Scales (DMRS), applied to session-transcripts, of assessment of defenses was used. A matched, nonclinical control group was introduced. Defense specificities in BD encompass a set of 5 immature defenses, of which omnipotence is linked with symptom level. The level of the therapeutic alliance is predicted by mature defenses. These results are discussed with regard to the psychological vulnerability of BD, and treatment implications for psychodynamic psychotherapy with such challenging patients are evoked.

Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care.

UNLABELLED: The aim of this study was to compare perceived barriers to and the most preferred age for successful transition to adult health care between young people with chronic disorders who had not yet transferred from pediatric to adult health care (pre-transfer) and those who had already transferred (post-transfer). In a cross-sectional study, we compared 283 pre-transfer with 89 post-transfer young people, using a 28-item questionnaire that focused on perceived barriers to transition and beliefs about the most preferred age to transfer. Feeling at ease with the pediatrician was the most important barrier to successful transition in both groups, but was rated significantly higher in the pre-transfer compared to the post-transfer group (OR = 2.03, 95 %CI 1.12-3.71). Anxiety and lack of information were the next most important barriers, rated equally highly by the two groups (OR = 0.67, 95 %CI 0.35-1.28 and OR = 0.71, 95 %CI 0.36-1.38, respectively). More than 80 % of the respondents in both groups reported that 16-19 years was the most preferred age to transfer; more than half of all the respondents reported 18-19 years and older as the most preferred age. CONCLUSION: Better transition planning through the provision of regular and more detailed information about adult health-care providers and the transition process could reduce anxiety and contribute to a more positive attitude to overcome perceived barriers to transition from young people's perspective. Young people's preferences about transferring to adult health care provide a challenge to those children's hospitals that transfer to adult health care at a younger age.

Communication that values patient autonomy is associated with satisfaction with care: a systematic review

Question: Which communication factors used by clinicians during patient-clinician interactions are associated with satisfaction with care? Design: Systematic review with meta-analysis of studies investigating the association of verbal or nonverbal factors or interaction styles used by clinicians with patient satisfaction during an encounter between clinician and patient. Participants: Clinicians interacting with patients in primary care or rehabilitation settings. Results: Twenty-seven studies investigated 129 verbal, nonverbal, and interaction style factors. of these, 38 factors were consistently associated with satisfaction. Verbal factors concerning clinicians involving, facilitating, and supporting patients were associated with satisfaction with care. Most communication factors presented a fair correlation (r >= 0.21 but < 0.41) with satisfaction with care. Nonverbal factors such as time spent discussing prevention and time spent reading patient charts had a fair association with satisfaction with care (correlations range from 0.21 to 0.40). A moderate association was found between interaction styles such as caring (pooled r = 0.51, 95% CI 0.42 to 0.60) and satisfaction with care. Over half (58%) of the 129 identified factors never associated with satisfaction with care and the remainder associated inconsistently. Conclusion: The number of potential modifiable communication factors associated with satisfaction with care and the magnitude of their association partially support interventions to train clinicians in communication skills that value patient autonomy. [Oliveira VC, Refshauge KM, Ferreira ML, Pinto RZ, Beckenkamp PR, Negrao Filho RF, Ferreira PH (2012) Communication that values patient autonomy is associated with satisfaction with care: a systematic review. Journal of Physiotherapy 58: 215-229]

Nurse-patient communication while performing home dialysis: The patients' perceptions

This study aimed at describing patients' perception of their communication with nurses when performing home dialysis. Data were collected from interviews guided by the question: What is communication like, between you and nurses, during home dialysis treatment? Results show participants' perception of treatment during home peritoneal dialysis [Continuous ambulatory peritoneal dialysis (CAPD)]; relationship with nurses and family and the effects of treatment on one's existence. Patients can be self-caring and they learn to value the autonomy in their own care. However, some are unable to assume the responsibility for self-care. It was discovered that the connotation of inspection that some participants attributed to the nurse's visits, led to an alienation from the education process in the CAPD education. Findings suggest that effective communication and the development of the relationship of a working partnership with patients is crucial. Improvement in the nurses' communication, aiming at adapting it to the characteristics, limitations and specific needs of each patient, is significant for achieving better outcomes. © 2010 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Avaliação do conhecimento dos cirurgiões dentistas que realizam curso de especialização na Universidade Estadual Paulista-UNESP, sobre aspectos bioéticos, éticos e legais do tratamento odontológico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

[The image of dentistry. Part 2: The ideal dentist]

Our second part of the publication entitled "The image of Dentistry" discusses the properties that correspond to the ideal image of dentistry or even the ideal scientist such as the management of the dental practice, the dentist-patient relationship and the appropriate handling of the patient's emotions such as anxiety or pain. The quality of treatment and the friendly, honest and compassionate attitude of the dentist can immediately affect the image of dentistry. Therefore, the dental professional must try to keep the balance between practice profit, staffing and patient well-being in order to fulfill both social and public health responsibilities.

[The deaf patient--information for a barrier-free conversation with patients in dentistry]

There are about 650,000 people with hearing problems in Switzerland, 10,000 of whom use sign language. About 100,000 people are hard of hearing. Deaf patients require special treatment in the dental office as they have specific communication needs. This community, like many other minority groups, has a sign language and a culture of its own. To prevent misunderstandings it is therefore very important to provide solutions for an enhanced communication. However, guidelines for the communication with deaf dental patients are still missing. Successful communication between deaf patients and dentist is essential for effective care. This paper is concerned with providing background information and introducing recommendations for unrestricted dentist-patient communication. The aim of this article is to improve dentists' knowledge of the appropriate communication with this patient group.

Persuasive email messages for patient communication.

To improve health and reduce costs, we need to encourage patients to make better health care decisions. Since email is widely available, it may be useful for patient-directed interventions. However, we know little about how the contents of an email message can influence a health-related decision. We propose a model to understand how patients may process persuasive email messages.

The doctor, is career, his business, his human relations.

"Principles of medical ethics of the American Medical Association": p. 136-146.

Tratamento da retinopatia diabética: percepções de pacientes em Rio Claro (SP) - Brasil

PURPOSE: To collect information and opinions from a group of diabetic patients regarding diabetic retinopathy and its treatment, in order to get reliable information that can help to improve programs and actions to control and prevent this ocular disease. METHODS: A cross-sectional study was performed. The sample was from 980 diabetic patients seen in a diabetic association. A previous questionnaire was made with general questions about the main subject. Thereafter, an appropriate questionnaire was prepared. RESULTS: The sample showed that among 299 patients with age ranging from 16 to 83 years, with a mean of 57 years, mainly female (67.91%) did not know how severe their disease was (30.8%), or believed that it was not a serious problem (19.7%). The laser technique to solve diabetic retinopathy was known by 60.2% of the patients. It was reported as the only treatment available by 24.1%. Among the reasons for no treatment 59.8% reported that they did not think it was necessary and 29.7% could not afford it. CONCLUSIONS: Patients showed lack of knowledge about how serious is diabetic retinopathy, the possibility of using laser technique for it and the severity of the disease. Some patients believed in the efficacy of the treatment and some patients did not, but all of them reported that they were afraid of submitting to it.

Acupuntura: motivações de médicos para a procura de especialização

Este estudo quanti-qualitativo objetivou identificar concepções sobre Medicina Convencional e Acu puntura que contribuem para entender os motivos que levam médicos a procurarem conhecer ou se especializar em Acupuntura. Foram pesquisados 175 médicos do Curso de Desenvolvimento em Me dicina Chinesa − Acupuntura, do Center-AO − Centro de Pesquisa e Estudo da Medicina Chinesa e Universidade Federal de São Paulo − Escola Paulista de Medicina (Unifesp - EPM), com questio nário composto por perguntas abertas e fechadas. Os dados obtidos foram analisados estatisticamente, e as respostas foram analisadas com a técnica de análise de conteúdo, buscando desvelar unidades de significado. A partir disso, foram estabelecidas categorias gerais e específicas, que passaram a dar significado aos discursos. Dessa forma, foram obtidos três grupos categoriais: "aprimoramento profis sional", "ampliar seu próprio horizonte de vida" e "compreender o paciente em uma dimensão mais abrangente". Nossos dados revelaram que os médicos desejam exercer a Acupuntura de forma inte grada à Medicina Convencional, no bojo da qual a Acupuntura vem se firmando como especialidade médica.

Sexual dysfunction in the Australian population

AIM: To describe the prevalence and forms of sexual dysfunction experienced by Australians, and compare these with people in the United States. METHODS: A cross sectional, telephone interview survey of a randomly selected sample of men (n = 876) and women (n = 908) aged between 18 and 59 years on the electoral roll in all states and territories of Australia (response rate = 61%) was conducted between November 1999 and April 2000. RESULTS: Large proportions of Australian men (55.0%) and women (60.5%) reported at least one sexual problem within the preceding year. More serious sexual dysfunction (> 3 symptoms) was observed in 13.2% of men and 19.7% of women. DISCUSSION: Australia and the USA are similar with regard to the high rate of symptoms of sexual dysfunction observed in the population. The low rate of treatment points to both patient and doctor reluctance to discuss sexual performance and practices.

Violence: les femmes font confiance au milieu médical [Partner violence: women trust health professionals]

In 2008, the department of gynaecology and obstetrics of a university hospital centre implemented a program addressing interpersonal partner violence (screening, prevention and care of the patient victims). A qualitative survey was conducted to identify the needs and feelings of patients. The results show that patients are in favour of being actively and directly questioned about violence during the consultation and that they trust medical doctors and nurses to help and support them.