Global strategy for asthma management and prevention

1 Front Matter 2 Executive Summary 3 Part I: Introduction to Reading 4 1. Introduction 5 2. The Process of Learning to Read 6 Part II: Who Are We Talking About? 7 3. Who Has Reading Difficulties? 8 4. Predictors of Success and Failure in Reading 9 Part III: Prevention and Intervention 10 5. Preventing Reading Difficulties Before Kindergarten 11 6. Instructional Strategies for Kindergarten and the Primary Grades 12 7. Organizational Strategies for Kindergarten and the Primary Grades 13 8. Helping Children with Reading Difficulties in Grades 1 to 3 14 Part IV: Knowledge into Action 15 9. The Agents of Change 16 10. Recommendations for Practice and Research 17 References 18 Biographical Sketches 19 Index

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Preventing reading difficulties in young children

Adherence to the medical regimen continues to rank as a major clinical problem in the management of patients with essential hypertension, as in other conditions treated with drugs and life-style modification. This article reviews the psychometric properties and tests the concurrent and predictive va

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Concurrent and predictive validity of a self reported measure of medication adherence

Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such con- cepts is described and illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capa- ble of translating concepts from cultural anthropology into clinical language for practical application. The implemen- tation of this approach in medical teaching and practice requires more support, both curricular and financial.

https://focus.psychiatryonline.org/doi/pdf/10.1176/foc.4.1.140

Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research

Eight hundred patient visits to the walkin clinic of the Childrens Hospital of Los Angeles were studied by means of tape recording the doctor-patient interaction and by follow-up interview. Seventy-six percent of the patient visits resulted in satisfaction on the part of the patient9s mother; in 24% there was dissatisfaction. A number of communication barriers between pediatrician and patient9s mother were found to contribute significantly to patient dissatisfaction: notably lack of warmth and friendliness on the part of the doctor, failure to take into account the patient9s concerns and expectations from the medical visit, lack of clearcut explanation concerning diagnosis and causation of illness, and use of medical jargon.

Gaps in doctor-patient communication. 1. Doctor-patient interaction and patient satisfaction.

Study of 800 outpatient visits to Childrens Hospital of Los Angeles to explore the effect of the verbal interaction between doctor and patient on patient satisfaction and follow-through on...

Gaps in doctor-patient communication. Patients' response to medical advice.

Over the past 5 years the research team at the Childrens Hospital of Los Angeles has been investigating the problem of doctor-patient communication a crucial but neglected aspect of medical care. Medical schools continue to leave the learning of the "art" of medical practice to the individuals own initiative and intuition which is a serious omission. The emergency clinic of the Childrens Hospital satisfied the objective of a setting that would enable the team to examine selectively the doctor-patient communication process itself. Children are brought to this walk-in clinic with a great variety of acute illnesses or accidental injuries invariably accompanied by a parent. The visit usually is short and generally yields a specific recommendation from the doctor to the parent. The clinic has a large staff of pediatricians mostly young well-trained full-time residents. In basic study 800 visits by 800 different patients were observed. As the interaction was primarily between the childs mother and the doctor the mother was designated as "the patient." The standard procedure was to make an audio tape recording of the entire interview then question the mother immediately afterward concerning what she had expected from the visit and her reactions to it. A follow-up was conducted within 14 days to learn whether or not the mother had complied with the doctors instructions. Of the entire group 40% were highly satisfied 36% moderately satisfied 11% moderately dissatisfied and 13% highly dissatisfied. The fact that 76% of these anxious mothers were more or less satisfied with the doctors performance in their brief encounter in the clinic was reassuring. Their specific reactions were less favorable. Nearly 1/5 149 mothers felt they had not received a clear statement of what was wrong with their baby; almost half of the entire group were still wondering when they left the physician what had caused their childs illness. 42% of the mothers had carried out all of the doctors medical advice 38% had complied only in part and 11% not at all. A substantial correlation was found between the mothers expressed satisfaction with the doctors behavior in the visit and their compliance with his instruction. The general impression that physicians tend to be too technical in language for their patients was confirmed strongly by the study. The most severe and most common complaint of the dissatisfied mothers was that the physician had shown too little interest in their great concern about their child.

Doctor-patient communication.

Extract: As one of several approaches to scientific analysis of doctor-patient communication 285 visits to a pediatric walk-in clinic were scrutinized using an expanded version of Bales' Interaction Process Analysis Data analysis consisted of individual case studies and computer programs for descriptive summaries of cases and index scores. Factor analysis and chi-square calculations were among the methods used to test significant relations between attributes of the doctor-patient interaction and the dependent variables, patient satisfaction, compliance, and demography. As hypothesized, a distinctive behavior pattern emerged for doctor, parent, and child. Doctors were found to talk more but show less emotion than mothers. Almost two-thirds of the mother's communication related to medical history, while the doctor discussed history and treatment but gave little reassurance or friendlines to the mother, almost half of his conversation with the child consisited of friendly statements. In general, outcome of the medical consultation was found to be favourably influenced by having physician who was friendly, expressed solidarity, took some time to discuss nonmedical, social subjects, and gave the impression of offering information freely without the patients having to request it or feeling excessively questioned. Speculation: Because of the complicated nature and limited methods available for study, the doctor-patient relation has rarely been subjected to scientific inquiry or attempts at quantification. It is hoped that the present effort as well as other ongoing studies will contribute to a body of scientific information which in itself may have application for pediatric education and practice and which ultimately might contribute one approach in urgently needed studies of the quality of medical care.

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Gaps in Doctor-Patient Communication: Doctor-Patient Interaction Analysis

Fourteen patients (13 of them adolescents) interrupted immunosuppressive treatment following renal transplantation. Twelve were girls and two were boys. Six subsequently lost their allografts and eight had impaired renal function. Noncompliance was suspected when diminution in cushingoid features, unexplained weight loss, or changes in renal function occurred. Noncompliance was comfirmed by interview with psychosocial staff. Available psychosocial data from family interview and personality test obtained earlier as part of systematic follow-up study were analyzed to explore the reasons for noncompliance. Non compliant patient families had lower incomes, more fatherless households, and comunication difficulties within the family and with the medical establishment. Using a stepwise discriminant analysis, a discriminant function was derived which selected 13 of 14 noncompliant patients. Noncompliance may be a preventable cause of allograft failure. These data can aid in identifying high-risk patients and planning intervention programs.

https://pediatrics.aappublications.org/content/pediatrics/63/1/109.full.pdf

Barbara M. Korsch

Papers

Gaps in doctor-patient communication. 1. Doctor-patient interaction and patient satisfaction.

Gaps in doctor-patient communication. Patients' response to medical advice.

Doctor-patient communication.

Gaps in Doctor-Patient Communication: Doctor-Patient Interaction Analysis

Noncompliance in Children With Renal Transplants