Technical tips: beyond the double banana.

We illustrate the utility of T1 and T2 electrodes (Silverman 1960) and of the lower circumferential tier of electrodes in improving the detection, localization, and confirmation of potential epileptiform signatures. We occasionally employ current source density (CSD) maps.

Discrepancy between patients' use of and health providers' familiarity with CAM.

OBJECTIVE: To compare patients' complementary and alternative medicine (CAM) use and physicians' familiarity with certain CAM modalities in the same setting and to assess patient-provider dialogue about patients' CAM use. METHODS: An observational survey study with convenience sampling at ambulatory family medicine clinics in two Texas cities. A total of 69 healthcare providers and 468 patients completed the surveys. Patients' surveys assessed use of 27 CAM therapies, perception of CAM use and interaction with providers. Providers' survey assessed perception and attitude toward CAM use. RESULTS: CAM modalities most used by the patients are not those modalities that providers best understood. Of the 330 patients (70%) who responded to the relevant questions about discussing CAM, 44.5% reported never having discussed CAM use with their providers. Binomial logistic regression revealed no link between age, gender or ethnicity for discussing CAM with providers. College-educated patients (adjust OR=2.8, 95%CI=1.3-6.0) and US citizens were both about three times more likely to discuss CAM than their counterparts. CONCLUSION: Lack of knowledge and unfamiliarity with CAM modalities might prevent important patient-provider discussions. PRACTICE IMPLICATIONS: Providers should use existing resources and encourage a bilateral dialogue that involves transferring of information and assisting patients in decisions making about CAM use and health care.

A study to examine the attitudes, knowledge, and utilization of CAM by primary care professional in West Texas.

OBJECTIVE: This study examined the attitudes, knowledge, and utilization of CAM among primary care providers at two campuses of the Texas Tech University Health Sciences Center (TTUHSC). DESIGN AND SETTING: A cross-sectional study design and a convenient sampling method were used. This study employed the questionnaire adapted from the Wahner-Roedler's study to survey participants in TTUHSC. Primary survey collection was conducted at the two campuses where all Family Medicine healthcare professionals were recruited. MAIN OUTCOME MEASURES: We measured participants' knowledge of, their familiarity and experience with, their attitudes towards and utilization of CAM. RESULTS: Of the 69 respondents, more than half (56.5%) were female and younger than 36 years. Overall, our study revealed a positive attitude towards CAM. More than 60% of the providers would like to refer a patient to a CAM practitioner and about 75% of them believed that incorporation of CAM therapies into the practice would have a positive impact. Providers were most familiar with and felt most comfortable counseling their patients about massage therapy and St. John's Wort among all CAM modalities. About 70% of the participants believed that the institution should offer proven CAM therapies to patients. CONCLUSIONS: This study provides some preliminary findings that may lead to further exploration of healthcare professional's attitudes towards CAM.

Use of the internet for health information among primary care patients in rural West Texas.

BACKGROUND: Little is known about how primary care patients in rural, remote or border areas use the internet for their health information. This study examined the factors related to internet use for medical information among primary care clinic patients in such areas of West Texas. METHODS: A convenience sample was drawn from nine clinics that serve low-income rural area populations. Surveys were distributed to the patients during a 6-week period in the winter of 2006. The analytical sample included 1890 participants. Logistic regressions were conducted. RESULTS: Of 1890 subjects, 699 (37%) reported having used the internet for medical information. Among those who reported using the internet for health information, respondents' primary usage pattern was to request more health information (29.9%), followed by the purchase of health supplies (13.4%). Most internet users (78.8%) agreed that the online medical/health information had improved their understanding of a specific condition, disease, or treatment. Almost 60% of the internet users thought the information was reliable. The correlates of internet use included health insurance, self-rated health, health confidence, and number of worried days as well as age, education level, ethnicity, and language. CONCLUSIONS: Our findings showed a much lower rate of internet use for medical/health information compared with a 2006 nationwide survey. This finding suggests that promoting health/medical information through websites or other on-line resources might not be the most effective way to reach a majority of patients in remote, rural or border areas.

Complementary and alternative medicine use among primary care patients in west Texas.

BACKGROUND: This study explored factors related to practitioner-based complementary and alternative medicine (CAM) usage among primary care clinic patients in rural West Texas areas, including physicians' awareness of their patients' CAM use. METHODS: A convenience sample was drawn from nine clinics that served low-income populations. Surveys were distributed to patients during a 6-week period in the winter of 2006. The analytical sample included 1731 participants. Logistic regressions were conducted to explore the factors related to CAM use. RESULTS: Of 1731 subjects, 52.0% (900) reported that they were currently using or had used CAM. The main types of CAM practitioners were chiropractor (42.7%) followed by massage therapist (33.3%) and herbalist (8.3%). Those who had discussed the use of alternative medicine with their physicians and those who had more days where they felt worried in the past 30 days were more likely to use CAM than their counterparts. Patients whose healthcare was covered by nonprivate insurance, those who rated their healthcare providers more highly, and those who agreed that their doctor visits were obtainable were less likely to use CAM. CONCLUSIONS: CAM use is clearly not uncommon among primary care patients in rural areas, with more than half of patients reporting some type of use. This study suggests that further research should elicit opinions on CAM among people who do not regularly access a conventional primary care provider, as well as assess the relationship between CAM and conventional medical treatment in terms of cost and health benefits.

Geriatric screening and preventive care.

Preventive health care decisions and recommendations become more complex as the population ages. The leading causes of death (i.e., heart disease, malignant neoplasms, cerebrovascular disease, and chronic lower respiratory disease) among older adults mirror the actual causes of death (i.e., tobacco use, poor diet, and physical inactivity) among persons of all ages. Many aspects of mortality in older adults are modifiable through behavior change. Patients 65 years and older should be counseled on smoking cessation, diets rich in healthy fats, aerobic exercise, and strength training. Other types of preventive care include aspirin therapy; lipid management; and administration of tetanus and diphtheria, pneumococcal, and influenza vaccines. Although cancer is the second leading cause of death in patients 65 years and older, a survival benefit from cancer screening is not seen unless the patient's life expectancy exceeds five years. Therefore, it is best to review life expectancy, functionality, and comorbidities with older patients when making cancer screening recommendations. Other recommended screenings include abdominal aortic aneurysm for men 65 to 75 years of age, breast cancer for women 40 years and older with a life expectancy greater than five years, and colorectal cancer for men and women 50 years and older with a life expectancy greater than five years.