A questionnaire for patients' evaluations of their physicians' humanistic behaviors.

OBJECTIVES: To determine what behaviors patients perceive as reflecting a physician's humanistic qualities, to develop an instrument for patients to use to assess the humanistic behaviors of their own physicians, and to compare patient assessment of residents' humanistic behaviors with patient satisfaction and the assessment of attending physicians. DESIGN: Cross-sectional descriptive study, using patient interviews and questionnaires, and evaluations of residents by attending physicians. SETTING: Inpatient medical service in a tertiary care teaching hospital and in a primary care internal medicine clinic. PARTICIPANTS: Six medical interns and six medical residents, 119 medical patients in the hospital, and 111 patients in the internal medicine clinic. MEASUREMENTS AND MAIN RESULTS: The 25-item Physicians' Humanistic Behaviors Questionnaire (PHBQ) was developed from patients' statements about important humanistic behaviors. The mean PHBQ scores were 4.46 +/- 0.22 (mean +/- SD, on a scale of 1 to 5) in the clinic and 4.18 +/- 18 in the hospital (p = 0.003). The Spearman's rank correlations between the PHBQ and the Medical Interview Satisfaction Scale (MISS) were r = 0.8741 (p < 0.001) in the hospital and r = 0.8751 (p < 0.001) in the internal medicine clinic. The Spearman's rank correlation between the hospital PHBQ and the attending physician evaluations (for the six residents for whom the authors had complete data) was r = 0.5753 (p = 0.232). CONCLUSIONS: Patients can evaluate the humanistic behaviors of their physicians using the PHBQ. There is good correlation between the PHBQ and patient satisfaction, which supports the validity of the PHBQ. The relative lack of agreement between patients and attending physicians suggests different observations, criteria, or standards. The higher ratings from patients in the clinic compared with those from patients in the hospital suggest that residents' behaviors are different or that patients have different observations, criteria, or standards in the two settings. Therefore, a complete assessment of residents' humanistic behaviors may require sampling in both settings.

Does screening proctosigmoidoscopy result in reduced mortality from colorectal cancer? A critical review of the literature.

OBJECTIVE: To determine the strength of the evidence in the literature that screening proctosigmoidoscopy reduces colorectal cancer mortality. DESIGN: All English-language studies reporting mortality or survival from screening proctosigmoidoscopy published since 1960 were critically reviewed. DATA EXTRACTION: Fifteen references reported on five studies of screening proctosigmoidoscopy. Two authors independently reviewed each reference using explicit methodologic criteria, particularly for potential sources of bias. MEASUREMENTS AND MAIN RESULTS: Of the five studies, four used historical controls and were susceptible to bias, especially self-selection and lead-time bias. Only the Kaiser-Permanente Multiphasic Health Check-up study collected a representative patient sample from a defined population, had randomly allocated controls, and avoided multiple sources of bias. There was a reduction in mortality from a group of seven potentially postponable causes of mortality, including colorectal cancer, although no difference in overall mortality between screened and control groups was found. This study was not designed to determine specifically the impact of screening proctosigmoidoscopy on mortality from colorectal cancer, and suggested that most of the reduction in colorectal cancer deaths was due to a lower incidence in the screened group, which could not be attributed to polypectomy. The benefit of screening proctosigmoidoscopy in this study, if any, was small. CONCLUSIONS: The evidence in the literature is inadequate to determine whether or not screening proctosigmoidoscopy has an impact on colorectal cancer mortality, but the best available data suggest that the benefit is small, at best.

Rous-associated virus type 7 induces a syndrome in chickens characterized by stunting and obesity.

Infection of 10-day-old chicken embryos with an avian retrovirus. Rous-associated virus type 7, resulted in a disease characterized by stunting and hyperlipidemia. By 20 days after hatch, infected chickens were smaller than hatchmates and developed ataxia and obesity over the next 30 days. Histological examinations of livers from infected chickens revealed a diffuse panlobular fatty infiltrate involving an accumulation of fat in microdroplets. Electron microscopic examinations of livers from infected chickens revealed hepatocytes with swollen mitochondria that lacked cristae. The thyroid and pancreas were infiltrated with lymphoblastoid cells by 1 week after hatch. An examination of the blood revealed a mild anemia, a frank lipemia, and high levels of uric acid. This syndrome induced by Rous-associated virus type 7 in chickens may be useful for elucidating the nature of several diseases, including that found in the fatty liver and kidney syndrome of chickens and that observed in a strain of obese chickens.

Evaluation of anaerobic incubation for recovery of group A streptococci from throat cultures.

No statistical differences were found in the recovery of group A streptococci from throat culture specimens after overnight incubation of blood agar plates in 5% CO2 compared with anaerobiosis. Anaerobic incubation required many more subcultures and resulted in considerably greater technical time and expense.

Primary antituberculous drug resistance in Hawaii, 1957 to 1977.

A study of primary antituberculous drug resistance in Hawaii was conducted from 1957 to 1977 to determine the incidence of primary resistance with respect to time. A total of 1,869 initial cultures of Mycobacterium tuberculosis submitted to Leahi Hospital in Honolulu were screened to identify drug resistance. Of 256 patients who excreted resistant bacilli, only 55 had no history of previous antituberculous chemotherapy. The frequencies of primary drug resistance from July 1957 to July 1977 were as follows: streptomycin, 0.86 per cent; isoniazid, 1.2 per cent; para-aminosalicylic acid, 1.5 per cent. No strains were resistant to ethambutol or rifampin. A slight decrease in the incidence of drug resistance during a 20-year period was observed. This was especially significant because Hawaii's tuberculosis problem is principally confined to its foreighn-born population. Although no serious primary drug resistance problem was discovered, Hawaii possesses both the highest immigration rate and the highest incidence of tuberculosis in the United states. Therefore, there is a need for continued periodic monitoring of drug resistance in Hawaii.