Digital technology in medical visits: a critical review of its impact on doctor-patient communication.

With the rapid advances of digital technology, computer-mediated medical practices are becoming increasingly dominant in medical visits. However, the question of how to ensure effective, patient-centered communication in this transition remains crucial. In this mini-review, we explore this topic by reviewing quantitative and survey-based studies, as well as discursive-interactional studies that focus on the visit as a communicative event. The review is organized into four sections: the introductory section provides a brief synthesis of the two main models used in medical practice and describes the effects of patient-centered communication practices on patients' health and well-being. The second section presents and discusses qualitative and quantitative studies that assess the effect of technology on medical interaction and its impact on patient-centered communication. The third section focuses on whether and how the digital medical record represents a "potential communication risk" during doctor-patient interactions and explores how certain pen-and-paper literacy practices could help mitigate these challenges. In the concluding section, we outline and analyze three key considerations for utilizing technologies to foster and enhance patient-centered communication during medical visits.

Navigating Intercultural Medical Encounters: An Examination of Patient-Centered Communication Practices with Italian and Foreign Cancer Patients Living in Italy.

Effective communication is crucial in cancer care due to the sensitive nature of the information and the psychosocial impact on patients and their families. Patient-centered communication (PCC) is the gold standard for providing quality cancer care, as it improves patient satisfaction, treatment adherence, clinical outcomes, and overall quality of life. However, doctor-patient communication can be complicated by ethnic, linguistic, and cultural differences. This study employed the ONCode coding system to investigate PCC practices in oncological visits (doctor's communicative behavior, patient's initiatives, misalignments, interruptions, accountability, and expressions of trust in participants' talk, Markers of uncertainty in doctor's talk, markers of emotions in doctor's talk). Forty-two video-recorded patient-oncologist encounters (with 22 Italian and 20 foreign patients), including both first and follow-up visits, were analyzed. Three discriminant analyses were conducted to assess differences in PCC between patient groups (Italian or foreign patients) according to the type of encounter (first visit or follow-up) and the presence or absence of companions during the encounters. Multiple regression analyses were performed to evaluate the PCC differences by oncologist age, patient age, and patient sex, controlling for the type of encounter, the presence of a companion during the visit, and patient group on ONCode dimensions. No differences were found in PCC by patient group in discriminant analyses and regressions. Doctor communication behavior, interruptions, accountability, and expressions of trust were higher in first visits than in follow-ups. The disparities in PCC were primarily linked to the type of visit and the age of the oncologist. However, a qualitative analysis showed notable differences in the types of interruptions during visits with foreign patients compared to Italian patients. It is essential to minimize interruptions during intercultural encounters to foster a more respectful and conducive environment for patients. Furthermore, even when foreign patients demonstrate sufficient linguistic competence, healthcare providers should not solely rely on this factor to ensure effective communication and quality care.

Accomplishing Intergroup Relations in Group Homes: A Discursive Analysis of Professionals Talking About External and Internal Stakeholders.

Focusing on one of the most studied dimensions of Social Psychology, i.e., intergroup relations, this study analyzes its discursive accomplishment in a specific group-based intervention, i.e., the talk and work of an Italian group home, i.e., a small alternative care facility hosting a group of out-of-home children. Particularly, we focused on the fictionally called "Nuns' Home," a group home previously investigated for its ethnocentric bias, and its intergroup relations with "inside" and "outside" groups, such as schools, biological families, and social services. By combining a qualitative and quantitative approach in analyzing one audio-recorded ethnographic interview with the whole team of professionals, we aimed at accounting for the multitude of internal and external stakeholders that participants refer to, analyzing the discursive accomplishment of ingroup and outgroup in talk-in-interaction and investigating ingroup bias and group qualification. To do so, we detected social categorization markers and qualifying devices that participants rely on when referring to groups. Results show that, among the numerous groups recognized, participants co-construct intergroup relations and ingroup bias implying negative assessment over external groups. Being different from traditional laboratory studies illustrating substantial contraposition between ingroup and outgroup, our qualitative analysis reveals the multitude of groups by which the ingroup is formed and their internal fragmentation. To conclude, we discussed the implications of qualitatively studying intergroup relations in group homes and indicated future lines of research.

[Dialysis and cookers: a project for the empowerment of patients in managing their own chronic renal failure].

The phosphate and potassium control is indispensable to dominate the secondary hyperparathyroidism and reduce cardiovascular mortality in dialysis patients. Most of them receive only theoretical nutritional information. We therefore organized a cooking workshop for dialysis patients, with a multidisciplinary team consisting of nurses, nephrologists, a dietitian and a professional chef, to directly teach the patients and their families how to realize a low phosphorus and potassium menu, assessing the proper use of phosphate binders, and blood tests at baseline and at three and six months. Twenty-four patients, out of 133, attended the workshop with a family member, filling out a questionnaire on eating habits, knowledge about phosphorus and potassium, and about binders. Theoretical and practical information about phosphorus and potassium metabolism, about binders, and cooking techniques were given during the evening, we then prepared a meal, eaten all together. The questionnaire was repeated at the end of the evening, and all the participants reported an improvement of the considered variables. Phosphorus and potassium plasma levels and the number of binders did not change after three and six months. Coping with the dietary changes related to the start of the dialytic therapy in an informal atmosphere, with a family member, is highly appreciated, clinically useful, logistically and economically sustainable. A customized and long-lasting counselling is probably required to modify plasma levels of phosphorus and potassium and binder's consumption. The poor dietary knowledge detected in our patients and the satisfaction about the course both confirm the training needs in this area.

Leiomiossarcoma mixóide uterino / Myxoid leiomyosarcoma of the uterus

Um caso de leiomiossarcoma mixóide é descrito. O tumor caracterizou-se macroscopicamente pela aparência gelatinosa e limites aparentemente bem definidos. Histologicamente, contudo, observou-se invasäo do tecido circunjacente. Copiosas quantidades de estroma mixomatoso dificultou o reconhecimento da natureza muscular lisa das células neoplásicas em algumas áreas. A contagem de mitoses foi superior a dez em dez campos de 400 aumentos. Seguimento da paciente um ano após revelou ausência de neoplasia