Reliable measurement of student capability for a skill allows educators to verify student mastery. A major part of a physician's ability to gather information involves patient interviewing, and instruction of this skill is a substantial portion of a medical curriculum. Since 1974, the University of Arizona College of Medicine has employed patient-instructors (PIs), lay persons who function in the roles of patient and teacher for training of interview skills in the Preparation for Clinical Medicine (PCM) program. PIs provide "real" patient-interview experiences and immediate feedback to the students. The PCM program currently has four topic areas: Adult, Pediatric, Geriatric, and Psychiatric. The Arizona Clinical Interview Rating (ACIR) Scale was developed in 1976 to measure the technical performance aspects of interviewing. This study was undertaken to determine reliability of the ACIR. Implication of the results are discussed and suggestions made for the continued application of the ACIR Scale. (Abstract shortened with permission of author.)

Following an introduction giving the reasons for writing on Thomas Laycock, there are two chapters of personal biography making use of his unpublished personal Journal. An account is then given of his papers on hysteria and the thinking which led from hysteria to reflex brain function. Next a chapter is devoted to Laycock's writings on public health and his involvement with Edwin Chadwick in the preparation for the City of York of The Report on the state of Large Towns and Populous Districts. Laycock always had a special interest in medical psychology and extended reflex action to explain some of the phenomena of mental illness and memory. An account is also given of his various other writings related to psychiatry. He was aware that extending reflex function to the brain would result in various philosophical and theological problems and Laycock's opinions are given on these issues together with a brief account of his classical work Mind and Brain. Having a great interest in medical psychology, also being a lecturer at the York Medical School and later Professor of the Practice of Physic at Edinburgh, it was natural he should be a pioneer in the teaching of the subject. Many fascinating ideas are to be found in Laycock's writings on general medicine, especially his use of neurology to explain oedema and certain types of pulmonary disease. A trophic nervous system was thought to cause tissue pathology which was a reversion to a lower evolutionary type. In his last decade Laycock wrote consolidating many of his previous ideas but attempted to bring these into line with then current scientific advances. A selection of his unpublished writings is examined in the same chapter. In his lifetime Laycock was not an influential person but he impressed a few of his more able students, several of whom were to become professionally distinguished. The careers of these are described. After some conclusions a bibliography, with notes. is provided of published and unpublished works used in this thesis.

Thesis (M.S.)--University of Wisconsin--Madison. / Typescript. eContent provider-neutral record in process. Description based on print version record.

During the development of medicine in nineteenth century Britain and the United States, the 'regular' profession was faced with severe competition from 'unorthodox' practitioners. Most significant amongst these were the professional homeopaths. They were just as ~ell educated and qualified as the regulars, and so they posed the deepest threat to their continued plausibility as the source of all that was 'Good', 'True' and 'Scientific' in professional medicine. The cognitive anxiety which professional homeopathy raised was further intensified by the fact that recruitment to the ranks of homeopathy was made from the regular profession itself. Many converts to homeopathy were prepared to pay the professional and personal costs of being labelled a 'quack' for the sake of their own integrity and the apparently more effective therapeutic certainties of homeopathy. They were prepared to abandon the systems of regular medicine, be they heroic, sceptical, neovigorous or eclectic, in order to be at peace with their own conscience, and to practice a system of medicine they were now convinced was far more effective than any form of regular therapy. During this period, regular medicine passed through three basic styles of theory and practice. These were the Heroic-Bedside, Clinical-Hospital and Bacteriological-Laboratory Medical Cosmologies. Particularly during the Heroic and Clinical phases, the regulars developed an anti-homeopathic ideology which they deployed in the various conflicts which ensued. I ts purpose was to define the homeopaths as 'deviants' and medical 'heretics'. The regulars did this by the use of a 'vocabulary of insult' which stigmatized their opponents. By further employing the tactics of intolerance and social control they were able to secure their own claims to political and 'scientific' legitimacy. However, the supposedly 'rational' and 'scientific' refutations of homeopathy by many eminent regular practitioners (such as Oliver Wendell Holmes and James Young Simpson) were actually constructed at a time when the therapeutic, pharmacodynamic and aetiological knowledge of regular medicine was immature and highly uncertain. I shall argue that the claimed refutation of homeopathy during the 1830's to 1860's was not, indeed could not be, accomplished on scientifically 'objective' grounds (i.e. on the grounds of intersubjectively testable, empirical and experimentally reproduceable knowledge). Therefore, its actual grounds were those of conventional professional social norms, practices and traditions. The defence of regular medicine by means of an anti-homeopathic, anti-quack ideology and the rhetorical claim to 'scientificity' was a sign of an insecure and crisis-ridden profession. It was dangerous for regulars to admit, both professionally and personally, the therapeutic efficacy of homeopathy claimed by its adherents. For the majority of the regulars, the cost - emotional, cognitive and social – would be too high. In these terms (rather than mere professional duplicity) we can explain the attempted suppression of the statistical returns of the London Homoeopathic Hospital, which showed the success of their treatments, from the official report on the 1853/54 cholera epidemic. A mature scientific therapeutics began to develop with the emergence of the bacteriological research programme, based upon the work of Robert Koch. He was able to provide a secure experimental, methodological and ontological basis for the germ theory of disease causation. However, its therapeutic fruitfulness was not realised in practice (for people that is) until the 1890's, with the mass manufacture of diphtheria anti-toxin based upon the research of Emil von Behring. Therefore, the known development of medicine, and especially of therapeutics, does not support the claim by the regulars during the nineteenth century (and after) that homeopathy was refuted by unambiguous experimental, clinical and 'scientific' means. The actual means to do that did not emerge upon the historical scene until 1876 at the earliest (with Koch's bacteriological work) and with fuller effect not until the 1890's. However, by that time the conflict between regular and homeopathic practitioners was no longer of any interest to the centres producing standardized scientific knowledge; the bacteriological laboratories of university-hospitals, the proprietary drug industry, and various government and private research institutes. The 'refutations' of homeopathy developed a half-century earlier, were taken to be sufficient warrant to continue to (a) reject homeopathy cognitively, if not legislatively,- and (b) refuse it the courtesy of agreed experimental test when the actual means to do so were then available. Therefore, within the asymmetries of power, structures of domination and mechanisms of social control developed by the regulars in their pursuit of 'scientific' legitimacy, occupational closure and market monopolisation, the homeopaths were marginalized. However, they were not completely powerless against the regulars. They were able to obtain some important compromises and concessions from them, even if what was gained in America turned out to be far more temporary compared to the moral and legislative achievements of their less numerous British counterparts. The medical historians standard model to explain the 'success' of 'scientific' regular medicine and the 'failure' of 'unscientific' homeopathic medicine, as the result of the progressive, linear, accumulation of 'facts' is no longer adequate to the task. This is because of the model's/historian's assumptions that the ideological evaluations already performed in relation to those it has stigmatized as 'unscientific' and (or because) 'unorthodox', during the nineteenth century, were (and are) epistemologically 'True' and l:npolluted by political/ideological interest. It is the purpose of this work to demonstrate that such a science/ideology polarity is unable to adequately explain the historical rejection of homeopathy throughout the century and to propose a conception of monopoly, marginality, power and ideology which is adequate to that task.

The ability to gather accurate and complete information is important in scientific endeavors and the field of medicine is no exception. The medical interview is one of the primary methods by which the physician gathers information. His/her method should be no less than that used by the scientist. There are two components to the medical interview: The content, or the specific information, and the process, or the method by which the information is obtained. Traditional methods for teaching interviewing skills to medical students emphasized an on-the-job type of experience with students going out on the wards to interview actual patients. The method had several problems including lack of standardized methods of teaching and evaluating. This dissertation looks at a competency-based method of teaching and evaluating medical interview skills used at The University of Arizona College of Medicine. It uses patient instructors (PIs) to objectively evaluate interviewing skills. PIs are highly trained non-physicians who have been trained to function as patients, teachers, and evaluators. Analysis of the data collected on student interview performance from the classes of 1982-1984 indicated that there was no significant difference in content or process scores due to sex or prior occupational experience in a health-related profession. However, significant differences were found in content and process scores due to the age of the interviewer with students older than the class average scoring higher than the younger students.

Objective--Identify patient history intake questions common to four fields of medicine - allopathic, naturopathic, chiropractic and Traditional Chinese Medicine to be included in an Integrated Patient History Intake Tool. Background--The use of complementary and alternative medicine (CAM) is on the rise in the United States. 80% of those who used CAM therapies in 1990 did so in conjunction with allopathic medicine, and 70% of those who used CAM therapies did not tell their conventional practitioner. Lack of awareness of patients' use of CAM therapies may hinder practitioners' ability to provide adequate healthcare. Methods--A three-round modified Delphi technique was utilized to generate consensus among 106 Oregon health care practitioners on the importance of specific patient history intake questions. A panel of faculty members from Oregon Health and Sciences University, the National College of Naturopathic Medicine, the Oregon College of Oriental Medicine, and Western States Chiropractic College identified 321 patient history intake questions, which then were distributed to the Oregon healthcare practitioners. The healthcare practitioners were asked to rate the importance of each question through a series of two surveys over the period of eleven weeks. Suggestions for additional intake questions also were invited. Results--The Delphi process narrowed the 321 initial questions plus 150 additional suggested questions down to a list of 52 intake questions to be included in the Integrated Patient History Intake Tool. There was an overall response rate of 47% with a 64% response rate to SURVEY I, and a 74% response rate for SURVEY II. Discussion--The patient history intake questions have been identified for use in an Integrated Patient History Intake tool. This Delphi study illustrated the differences that are held unique for each paradigm of medicine. Determining unique characteristics of complementary and alternative medicine from allopathic medicine is an important aspect of building collaboration among allopathic and CAM providers within the state of Oregon. The proposed model of an integrated patient history intake form provides a platform from which to build further cooperation and awareness. / Graduation date: 2003

No description available.

Purpose: Pharmacists must ensure the safe and effective use of medication, but often have only the documented patient history to guide assessment of therapy. There is a lack of information on the incidence of claimed drug allergies or the validity of these self-reported drug allergies in the South African population. Mislabelling of patients as being allergic to medication often deprives them of important therapeutic drugs and alternative agents may be more dangerous, less effective and more costly (Hung et al., 1994). The aim of the research was therefore to determine the incidence of drug allergies in patients admitted to a private hospital and to assess the validity of these self-reported drug allergies. Methods: A descriptive, non-experimental study design was used. Data was collected using a concurrent, cross-sectional approach and collected from patients admitted to hospital using Medical Chart Reviews and researcher-led, questionnaire based interviews. During the seven month sampling period, 693 patients were identified with one or more self-reported drug allergies. A subset of 99 patients (14.2%) consented to a researcher-led interview. The allergies were assigned to one of three groups based on the history: (i) High probability: signs and symptoms typical of an immunological reaction. (ii) Low probability: signs and symptoms of the reaction were predictable reactions or side effects of the drug. (iii) Unknown status: no information concerning the reaction history was available. Results: A total of 953 allergies were identified in the 693 patients, with a ratio of drug allergy to patient of 1.4:1. The majority of claimed allergies were to penicillin (39.2%), opioid analgesics (17.6%), other antimicrobials, including co-trimoxazole (13.5%), NSAIDs (9.9%) and unspecified “sulphur” allergy (8.7%). Descriptions of the “allergic” reactions were only recorded on 8.9% (62, n=693) of the reviewed charts. Only 56.5% (35, n=62) of the symptoms recorded as “allergy” were indicative of the event being allergic or immunological in nature. In total, 1.3% (9, n=693) of the patients with a self-reported allergy received the allergen while in hospital. In three cases this was the result of a pharmacist overlooking the recorded allergy, and dispensing the allergen to the patient. A total of 118 allergies were identified in the 99 interviewed patients, with a ratio of drug allergy to patient of 1.2:1. Inaccurate allergy history was found in 9.1% (9, n=99) of the interviewed patients. Overall, the majority of self-reported drug allergies (67.8%) had a “high probability” of being a true drug allergy. Allergies that were assigned into the high probability group were: penicillin (74.1%), co-trimoxazole (91.7%), NSAID‟s (55.6%) and 75.0% of opioids. Conclusion: In summary, the validity of self-reported drug allergies need to be determined before excluding medication from a patient‟s treatment options. Detailed descriptions can assist in the evaluation of self-reported allergies which would be advantageous to both prescribers and patients. Pharmacists need to play a bigger role in ensuring accurate documentation of drug allergy history, with detailed descriptions, in order to ensure safe and effective drug use within the hospital environment.

This study offers a close, interdisciplinary reading of several specific instances in which health and sickness were discussed or considered by Locke and his contemporaries. Medical historians have long known that Locke was a medical adviser and practitioner of sorts, and his medical 'cases' have traditionally been scrutinised for details of his medical career and for details of past illnesses and treatments, read against a context of specifically medical thought. In a departure from that tradition, this study presents several of Locke's health-related interactions in their contemporary social contexts, These contexts are not exclusively medical, and it is shown how health issues overlapped with and permeated discussions of land, literature, gender, politics and religion. Focussing on specific micro-historical scenes, this study explores the myriad ways in which health was configured in Locke's world. In this study, we see Locke engaged in presenting the health of a colony in Carolina in America; employed in the management of Anthony Ashley Cooper's festering abscess; writing to the Fletchers of Saltoun about nature-hastening medicines and ignorant practitioners; subduing rumours about Matthew Slade, a mentally unstable scholarly friend; helping Elizabeth Northumberland to describe her searing pains, and more. In this thesis, stories of health from Locke's world are interwoven with similar short scenes of health from his published works to show the reader how Locke himself considered health-related scenes stimulating and illuminating.

The aim of this study was to determine the extent to which the cause of death in sudden natural death in adults could be ascertained without autopsy, based on information provided in the police report, and to evaluate any degree of error between that and the officially certified cause of death. Two methods were carried out: 1. A questionnaire-based retrospective survey of sudden natural deaths distributed to practitioners. The predicted cause of death was compared with the actual cause of death as determined after autopsy. The difference between the two causes of death was classified into 'no difference', minor and major difference according to the classification scheme developed for this study. 2. A prospective study of adult sudden natural deaths referred by the procurators fiscal in Lothian and Borders to the department during 2009 and 2010. The police reports were reviewed and a cause of death was ascribed by the author. This cause was compared with the actual cause of death in the final autopsy report and any difference assessed according to the classification scheme. In the view of the retrospective study results, it is possible to determine the cause of death which is with no or minor difference to that determined by autopsy if, in addition to provide sufficient information regarding deceased’s medical history and circumstances of death, the participants are given the option to select which cases should undergo external examination only. The prospective study results indicate that in certain circumstances the cause of death could be ascribed correctly based on the available information prior to autopsy. Causes of death such as ischaemic heart disease, hypertensive heart disease and alcohol related death are more frequently ascribed correctly. However, ischaemic and hypertensive heart disease were over-predicted. Results indicate that there are criteria to select which cases might be subject to a "view and grant" procedure with no significant loss of accuracy. The implications of the study for the development of medico-legal services are considered with specific reference to Kuwait.