Patients' extensive use of complementary and alternative medicine (CAM) can affect doctor-patient communication. Substantial numbers of patients expect their primary care physician to be able to refer them to CAM practitioners. However, a simple and practical referral CAM process is lacking.
We developed an 11-item questionnaire that addresses issues a physician should consider in determining whether to refer a patient for CAM treatment, including biopsychosocial and communication concerns and the safety and effectiveness of modalities. The tool was administered via questionnaires posted and e-mailed to primary care physicians and CAM practitioners.
Our CAM referral tool was found to be considerably useful in a primary care setting. High reliability and validity of the tool were found among the primary care physicians (Cronbach's alpha score of 0.867, spearman rho correlation 0.2-0.67) and moderate reliability among CAM practitioners (0.745).
We hope that our CAM referral tool will help advance the integration of CAM and conventional medicine.
"safety, efficacy, mechanism of action, cost). Further, through these discussions physicians can also explore patient treatment preferences, which previous research has suggested is important in CAM communication   . When adopting a neutral stance towards CAM use, physicians leave the door open to CAM use without explicit encouragement or discouragement. "
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To empirically investigate the ways in which patients and providers discuss Complementary and Alternative Medicine (CAM) treatment in primary care visits. METHODS: Audio recordings from visits between 256 adult patients aged 50 years and older and 28 primary care physicians were transcribed and analyzed using discourse analysis, an empirical sociolinguistic methodology focusing on how language is used to negotiate meaning. RESULTS: Discussion about CAM occurred 128 times in 82 of 256 visits (32.0%). The most frequently discussed CAM modalities were non-vitamin, non-mineral supplements and massage. Three physician-patient interactions were analyzed turn-by-turn to demonstrate negotiations about CAM use. Patients raised CAM discussions to seek physician expertise about treatments, and physicians adopted a range of responses along a continuum that included encouragement, neutrality, and discouragement. Despite differential knowledge about CAM treatments, physicians helped patients assess the risks and benefits of CAM treatments and made recommendations based on patient preferences for treatment. CONCLUSION: Regardless of a physician's stance or knowledge about CAM, she or he can help patients negotiate CAM treatment decisions. PRACTICE IMPLICATIONS: Providers do not have to possess extensive knowledge about specific CAM treatments to have meaningful discussions with patients and to give patients a framework for evaluating CAM treatment use.
[Show abstract][Hide abstract] ABSTRACT: If a number of drogues are continuously tracked during a sufficient period of time, not only average flow characteristics (shear, vorticity, divergence and stretching) but parameters of small-scale oscillatory motions (scales of eddies, their life times and translations, as well as eddy coefficients) can be computed. To do this, a computational technique is developed using the Obukhov-Kolmogorov hypothesis of cascaded energy transfer in horizontally isotropic fields. Lagrangian field experiments in Eastern Long Island Sound and Southern Lake Champlain were used to test the method. It is demonstrated that turbulent parameters are closely related to average kinematic properties of the flow.
[Show abstract][Hide abstract] ABSTRACT: This paper proposes a new communication protocol, SNP (SoC Network Protocol), for SoC design. SNP in the basic mode uses only about three fifths of the wires used by widely used AMBA AHB bus. To reduce bandwidth degradation due to the reduction of wires, SNP proposes a new phase-restoration feature that skips control and/or address signals whenever they are redundant. For efficient bandwidth utilization and real-time support, a phase-interleaving scheme is proposed. In order to reduce the number of wires further, SNP defines reduced modes that use fewer signals than the basic mode. An analysis shows that the bandwidth of SNP is greater than that of the widely used AMBA AHB when the communication traffic includes more burst transactions than single transactions in spite of having wires only about three fifths of AHB.
Communications, Circuits and Systems, 2004. ICCCAS 2004. 2004 International Conference on; 07/2004
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