Parent satisfaction with children's medical care. Development, field test, and validation of a questionnaire.

Research on both adult patients and parents of pediatric patients has demonstrated that satisfaction with medical encounters predicts such important outcomes as compliance with medical regimen. The authors developed a questionnaire to measure parent satisfaction with children's medical encounters, administered it to 104 parents of pediatric patients (field trial 1), and revised it. The revised Parent Medical Interview Satisfaction Scale (P-MISS) was then tested on a new sample of parents whose medical visits were videotaped (field trial 2). On field trial 2, the P-MISS showed a high alpha reliability (0.95). The four factor-based subscales identified by field trial 1 showed high alpha reliabilities on field trial 2: physician communication with the parent (0.81); physician communication with the child (0.93); distress relief (0.85); and adherence intent (0.86). With the exception of the distress relief subscale, the subscales appear to measure distinct dimensions of satisfaction. Objective ratings of physicians' interpersonal skills to parents during medical interviews correlated significantly with parents' total satisfaction scores as well as with all four satisfaction subscale scores, providing preliminary evidence of the construct validity of the P-MISS.

N-nitrosamines in the rubber and tire industry.

Airborne N-nitrosomorpholine (0 to 27 micrograms per cubic meter) was found in two of four rubber industry factories. N-Nitrosodimethylamine was also found in two factories, but at lower levels. These findings may be relevant to the reported increased risk of certain types of cancer in rubber workers in some of the same areas where the N-nitrosomorpholine levels were highest.

Interaction exchange structure and patient satisfaction with medical interviews.

The verbal interaction between patients and physicians in 52 initial interviews in a university hospital screening clinic was studied using a new discourse coding system. Factor analysis of category frequencies showed that each interview segment, medical history, physical examination, and conclusion, consisted mainly of two or three types of verbal exchange. Patient satisfaction with the interviews, assessed with a questionnaire that yields separate scores for satisfaction with cognitive and affective aspects, was found to be associated with exchanges involving the transmission of information in particular interview segments. Affective satisfaction was associated with transmission of information from patient to physician in "exposition" exchanges during the medical history, in which patients told their story in their own words. Cognitive satisfaction was associated with transmission of information from physician to patient in "feedback" exchanges during the conclusion segment, in which physicians gave patients information about illness and treatment.

PIP: Analysis of the verbal interaction between physicians and patients in 52 initial interviews at a university hospital screening clinic found a strong association between patient satisfaction and the provision of information. Factor analysis identified 2 principal types of verbal exchange in the medical history (exposition and closed question), 2 in the physical examination (further data and physical examination) and 3 in the conclusion (final clarification, feedback, and patient termination). Affective satisfaction, defined as patients' perceptions of warmth and understanding from their doctor, was associated with exposition exchanges in the medical history--i.e., patients being permitted to tell their story in their own words. Cognitive satisfaction--the patient's feeling that they understand their illness and its treatment--was associated with feedback exchanges in the interview's conclusion, i.e., physicians' giving objective information. The positive relationship between patient satisfaction and certain verbal interactions that enhance the exchange of information has been noted in previous surveys of patient satisfaction. The taxonomy of verbal response modes use in this study is a sensitive, flexible system that makes clinically relevant distinctions beyond the scope of other coding systems. Its use should be considered for further research on the effects of medical encounters and for specifying effective interviewing skills.

Verbal response mode profiles of patients and physicians in medical screening interviews.

The medical importance of the patient-physician relationship is widely acknowledged, but research on its effects has been hampered by the lack of a method to quantify its clinically relevant features. In this study a new method of coding verbal interaction was applied to 52 interviews with adults in a general medical screening clinic. "Average interaction profiles" for patients and for physicians in the medical history, physical examination, and conclusion segments of the interviews provided detailed descriptions of the relationship that appear to be accurate and coincide with descriptions derived from clinical experience, textbooks, and other studies. The profiles yield quantitative indexes of such crucial aspects of the relationship as the manner in which patients give a history and physicians trasmit information to patients.

The Medical Interview Satisfaction Scale: development of a scale to measure patient perceptions of physician behavior.

Patient satisfaction is a variable of increasing interest to researchers, clinicians, and medical educators. Of several studies reviewed, only a few have shown evidence of careful methodology. Most surveys have focused on general evaluations of doctors and/or health care services or of a particular facility. The present article reports the development of a scale to measure patient satisfaction with an encounter with a physician or other primary care provider. Methods of item generation and pretesting are detailed. The overall reliability of the scale (Cronbach's coefficient alpha) is 0.93. The distribution of satisfaction scores is broader than that reported for other scales and approaches the normal in shape. Clinical and research applications of the scale are suggested.

Comprehensive analytical procedures for the determination of volatile and non-volatile, polar and non-polar N-nitroso compounds.

The first comprehensive analytical procedures for the quantitative analysis of N-nitroso compounds are described. The scheme divides N-nitroso compounds into four major, overlapping categories: volatile (Class I), non-volatile, low polarity (Class II), non-volatile, non-ionic, high polarity (Class III) and non-volatile, ionic, high polarity (Class IV). Existing analytical techniques for each class of compound are integrated into an organized and logical sequence of analysis to allow all classes of compounds to be determined. TEA-GC is used for the volatile compounds and TEA-HPLC for the non-volatile. It is emphasized that the coincidence of retention time in either TEA-GC alone or TEA-HPLC alone cannot be taken as sufficient evidence for the identification of N-nitroso compounds, especially for samples from complex matrices. Independent techniques are required to confirm these results. The confirmatory techniques used frequently in our laboratory are: (1) spectroscopic analysis (IR, NMR, UV and MS), (2) formation and identification of derivatives, and (3) parallel TEA-GC/TEA-HPLC techniques. These procedures are now used at Thermo Electron for the comprehensive screening of environmental samples.