Volume 102, Issue 2

The purpose of this study was to identify communication styles and physician characteristics that correlate with improved patient adherence and satisfaction during geriatric healthcare interactions. A multiphase study design, incorporating the use of focus groups, socialization hours, educational seminars, and survey questionnaires, was used to discover the most effective methods for improving communication between physicians and their geriatric patients. Elders favored direct, interactive verbal communication over alternative communication styles such as role-playing activities or the use of visual aids. Chi-square analyses showed that men desired more time with medical providers than women, who instead expressed a preference for more thorough explanations of disease processes. Further, men--and African American men in particular--sought medical advice from trusted friends more frequently than did women, who often preferred to solicit medical advice from family members. The most significant barriers affecting physician-patient interaction were created by patients' inflated expectations for consultation time and by physicians' ineffective presentation styles. This study also reveals that physicians' characteristics and patients' gender and race also impacted the success of medical encounters.

Obsessive-compulsive disorder (OCD) is a common psychiatric disorder. It may go unrecognized, however, as many patients are embarrassed by their symptoms and are thus reluctant to report them. Recent research findings on OCD point to neurologic dysfunction in the circuitry of the orbitofrontal cortex and basal ganglia. The advent of the use of serotonin reuptake inhibitors (SRIs) as well as behavioral therapy has greatly improved treatment outcomes for patients with OCD. Given the likelihood that these patients are encountered in primary care consultations, physicians have the opportunity to play a crucial role in the early identification and proper treatment of OCD.

Although prehospital trauma guidelines call for spine immobilization for many trauma victims, there is a lack of clarity in medical institutions as to how trauma or emergency medicine physicians should proceed to remove cervical immobilization devices (CIDs) and "clear" the spine. Despite wide variations in physicians' approaches to such matters, however, certain specific aspects of vertebral assessment in such circumstances are well documented. The authors describe and explore several of these issues with respect to initial approach to the immobilized patient, clinical clearance of the spine, radiographic evaluation of the vertebrae in victims of blunt trauma, management of spine tenderness or pain, removal of CIDs, and indications for subspecialty consultation. Critical care physicians should be reminded that the responsibility lies with them for removing CIDs and halting other spine precautions--underlying the importance of careful consultation with radiologists and other specialists.

The discovery of a new class of effective migraine-abortive medications, the triptans, has sparked a new interest in the study of vascular headache. Over the past few years, the Food and Drug Administration (FDA) has approved six new abortive pharmacologic therapies, with several others in various stages of clinical trials. Unfortunately, concurrent pharmacologic changes in headache prophylaxis have not kept pace with their abortive counterparts. However, divalproex sodium (Depakote), which is approved by the FDA as a migraine prophylactic agent, is the first in the anticonvulsant class of medication for migraine headache and has expanded the options in headache treatment. The objective of this retrospective multicenter study of 284 patients with migraine or cluster headaches was to examine the clinical efficacy and safety of divalproex sodium as prophylaxis in monotherapy and in polytherapy. Sixty-one percent of migraineurs and 73% of cluster patients noted a decrease in pain with divalproex sodium and continued that therapy for more than 3 months. Reported negative side effects included weight gain, nausea, somnolence, tremor, alopecia, dysequilibrium, and rash. However, only 14% of subjects discontinued therapy due to these side effects. Overall, divalproex sodium was found to be an effective and generally well-tolerated prophylactic treatment option as monotherapy or in polytherapy for migraine and cluster headache.