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C Fullerton

Publications and source records attributed to C Fullerton.

11 recordsLinked to original sources

[Improving the quality of clinical interview teaching: evaluation of an intervention with medical students].

BACKGROUND: Quality of clinical interview is a key issue both for patient satisfaction and for diagnostic efficiency. Its adequacy relates to better clinical diagnosis treatment plans and patient compliance. AIM: To measure the quality of interviews performed by medical students in three Chilean medical schools before receiving specific training on the subject and to compare the scores obtained after introductory courses on interview. MATERIAL AND METHODS: The interviews were videotaped and then evaluated using an objective scale, that measures 33 skills grouped in six areas: opening, problem exploration, non verbal facilitation, interpersonal patient reaction and closing. The students were assigned to an experimental group that received an interactive workshop with role-plays, vignettes and videotape feedback, and to a non intervention group that received the usual bedside training on medical interviews. RESULTS: Both groups shared the same skill level before the training, with better scores on nonverbal, patient reaction and problem exploration, and worse ones on closing and interpersonal skills. Comparing pre and post-test results, the overall score improved in the experimental group (from 33.2 to 38.3, p = 0.002) and worsened among non intervened students. There were statistically significant changes for opening (p < 0.002), problem exploration (p < 0.05), non verbal facilitation (p < 0.0001) and closing (p < 0.0001). CONCLUSIONS: It is important to train students not only in specific knowledge contents but in the process of interview. This training should encourage the development of empathy and closing skills.

Education, Medical, Undergraduate↗

[Comorbidity of chronic diseases and psychiatric disorders among patients attending public primary care].

BACKGROUND: As a part of the World Health Organization multicentric study of emotional disorders in general medical care, we studied patients who had a chronic medical ailment and a psychiatric disorder, according to ICD-10. AIM: To report the prevalence of patients with coexisting medical and psychiatric disorders. PATIENTS AND METHODS: All patients, aged 15 to 65 years old, consulting in primary care outpatient clinics, were interviewed using a general health questionnaire. In a second phase, patients with chronic medical disorders were subjected to the World Health Organization Composite International Diagnostic Instrument. RESULTS: Sixty nine percent of interviewed Chilean patients had a medical condition, compared to 60.3% of the global study group. Of these, 66% had a coexisting psychiatric diagnosis, compared to 31% of the global study group. The most frequent diagnoses in the Chilean sample were somatization disorders in 25%, harmful alcohol use in 14%, depression in 35% and hypochondriasis in 6%. There was a higher prevalence and odds ratio for psychiatric diagnoses among Chilean women. CONCLUSIONS: Patients with chronic medical disorders should be considered a high risk group for the coexistence of psychiatric disturbances.

Adolescent↗

An international study of the relation between somatic symptoms and depression.

BACKGROUND AND METHODS: Patients with depression, particularly those seen by primary care physicians, may report somatic symptoms, such as headache, constipation, weakness, or back pain. Some previous studies have suggested that patients in non-Western countries are more likely to report somatic symptoms than are patients in Western countries. We used data from the World Health Organization's study of psychological problems in general health care to examine the relation between somatic symptoms and depression. The study, conducted in 1991 and 1992, screened 25,916 patients at 15 primary care centers in 14 countries on 5 continents. Of the patients in the original sample, 5447 underwent a structured assessment of depressive and somatoform disorders. RESULTS: A total of 1146 patients (weighted prevalence, 10.1 percent) met the criteria for major depression. The range of patients with depression who reported only somatic symptoms was 45 to 95 percent (overall prevalence, 69 percent; P=0.002 for the comparison among centers). A somatic presentation was more common at centers where patients lacked an ongoing relationship with a primary care physician than at centers where most patients had a personal physician (odds ratio, 1.8; 95 percent confidence interval, 1.2 to 2.7). Half the depressed patients reported multiple unexplained somatic symptoms, and 11 percent denied psychological symptoms of depression on direct questioning. Neither of these proportions varied significantly among the centers. Although the overall prevalence of depressive symptoms varied markedly among the centers, the frequencies of psychological and physical symptoms were similar. CONCLUSIONS: Somatic symptoms of depression are common in many countries, but their frequency varies depending on how somatization is defined. There is substantial variation in how frequently patients with depression present with strictly somatic symptoms. In part, this variation may reflect characteristics of physicians and health care systems, as well as cultural differences among patients.

Adult↗

[Comparative study of the frequency and features of emotional disturbances in patients in primary care clinics].

BACKGROUND: Psychological problems are a frequent cause of consultation in primary care outpatient clinics. AIM: To report the results for Santiago de Chile of the World Health Organisation multicentric collaborative study on Psychological Symptoms in General Health Care. PATIENTS AND METHODS: The results of 1453 patients that attended three primary care clinics in East Metropolitan Santiago were compared with those of patients studied in 15 other centers throughout the world. Two hundred fifty three cases were studied in detail with a structured diagnostic interview (CIDI-PHC). The capacity of general physicians to recognise emotional disorders as well as their management of psychological cases was also assessed. RESULTS: Among the 253 patients studied in detail, 53% of patients had a definite psychiatric diagnosis, compared with 24% of patients, as an average, in other countries. There was a higher prevalence of depression, generalised anxiety disorder, neurasthenia and harmful use of alcohol. Chilean physicians recognised 74.1% of patients with psychiatric conditions, as compared with 48.9% of physicians abroad. Tranquilizing agents were the most often prescribed medications (40%) followed by antidepressants (18%). CONCLUSIONS: There is a high prevalence of emotional disorders in patients consulting at the primary care level.

Affective Symptoms↗

[Patients cared for at the mental health unit of a primary care office: morbidity study].

Establishing the frequency of mental disorders among patients cared for at the mental health unit of a primary care outpatient clinic of Santiago, Chile, is intended. In this connection, 618 medical records have been screened retrospectively (i.e. a whole universe excepting patients under age 15). A great majority of patients--with an absolute ratio of female patients (88.8%) were referrals from physicians' offices. The most frequent disorders were anxiety disorders and adjustment disorders. Comments are made on (a): the scarcity of referrals from larger general hospitals, and (b) the need for mechanisms apt at an early detection of the most frequent disorders to be set up.

Adjustment Disorders↗

[Psychiatric patients from general hospitals: pathways followed before consultation].

A survey of all patients who consulted at the Psychiatric Service of a general hospital during a one month period was used to evaluate factors influencing the referral of the patient to the specialist. A preponderance of young females was observed. Patients presenting with somatic symptoms, anxiety or depression were usually referred from another physician, while patients with psychotic disorders and problems related to alcohol abuse were first seen by the specialist. Almost half of the patients had been previously treated, usually with anxiolytic drugs and the median time between the first consult and the referral was 52 weeks. Better systems for derivation of these patients must be developed.

Adolescent↗

Course of hypochondriasis in an international primary care study.

Hypochondriasis is frequently defined as a chronic condition distinct from anxiety and depressive disorders. Consecutive primary care attenders (n=25,916) were screened using the General Health Questionnaire and a stratified random sample (n=5447) completed a baseline diagnostic assessment. All patients with significant psychiatric symptoms and a random sample of remaining patients (n=3201) were asked to complete a follow-up diagnostic assessment 12 months later. Of patients meeting an abridged definition of hypochondriasis at baseline, 18% continued to do so at follow-up and an additional 16% continued to report hypochondriacal worries. 45% of those with hypochondriasis at follow-up also met criteria for DSM-IV anxiety or depressive disorder. Follow-up anxiety or depressive disorder was significantly associated with both onset and persistence of hypochondriasis. Hypochondriasis is moderately stable over time. The clear distinction between hypochondriasis and anxiety/depressive disorders suggested by ICD-10 and DSM-IV may be difficult to accomplish in practice.

Adolescent↗