scholarly journals Gaining Back What Is Lost: Recovering the Sense of Smell in Mild to Moderate Patients After COVID-19

2020 ◽  
Vol 45 (9) ◽  
pp. 875-881
Author(s):  
Lucia Iannuzzi ◽  
Anna Eugenia Salzo ◽  
Gioacchino Angarano ◽  
Vincenzo Ostilio Palmieri ◽  
Piero Portincasa ◽  
...  
Keyword(s):  
Rating Scale ◽  
Time Window ◽  
Substantial Improvement ◽  
Odor Identification ◽  
Olfactory Test ◽  
Olfactory Ability ◽  
Almost All ◽  
Olfactory Abilities ◽  
Visual Analog Scale Rating ◽  
Tdi Score

Abstract The purpose of our cohort study was to quantify olfactory deficits in Coronavirus disease 2019 (COVID-19) patients using Sniffin’ Sticks and a pre-post design to evaluate olfactory recovery. Thirty adult patients with laboratory-confirmed mild to moderate forms of COVID-19 underwent a quantitative olfactory test performed with the Sniffin’ Sticks test (SST; Burghardt, Wedel, Germany), considering olfactory threshold (T), odor discrimination (D), and odor identification (I). Results were presented as a composite TDI score (range 1–48) that used to define functional anosmia (TDI ≤ 16.5), hyposmia (16.5 < TDI < 30.5), or functionally normal ability to smell (TDI ≥ 30.5). Patients also self-evaluated their olfactory function by rating their ability to smell on a visual analogue scale (Visual Analog Scale rating) and answering a validated Italian questionnaire (Hyposmia Rating Scale). Patients were tested during hospitalization and about 2 months after symptoms onset. During the hospitalization, the overall TDI score indicated that our cohort had impairments in their olfactory ability (10% was diagnosed with anosmia and more than 50% were hyposmic). Almost all patients showed a significant improvement at around 1 month following the first test and for all the parts of the SST except for odor identification. None of the subjects at 1 month was still diagnosed with anosmia. We also quantified the improvement in the TDI score based on initial diagnosis. Anosmic subjects showed a greater improvement than hyposmic and normosmic subjects. In conclusion, within a month time window and 2 months after symptoms’ onset, in our cohort of patients we observed a substantial improvement in the olfactory abilities.

SEM Cold Stage Techniques for the Observation of Vegetative and Floral Apices of Oat (Avena sativa L.) Plants

1977 ◽  
Vol 35 ◽  
pp. 590-591
Author(s):  
B. K. Kirchoff ◽  
L.F. Allard ◽  
W.C. Bigelow
Keyword(s):  
Critical Point ◽  
Avena Sativa ◽  
Substantial Improvement ◽  
Fresh Tissue ◽  
Cold Stage ◽  
Critical Point Drying ◽  
Almost All ◽  
Cell Collapse ◽  
Conductive Paint ◽  
Carbon Based

In attempting to use the SEM to investigate the transition from the vegetative to the floral state in oat (Avena sativa L.) it was discovered that the procedures of fixation and critical point drying (CPD), and fresh tissue examination of the specimens gave unsatisfactory results. In most cases, by using these techniques, cells of the tissue were collapsed or otherwise visibly distorted. Figure 1 shows the results of fixation with 4.5% formaldehyde-gluteraldehyde followed by CPD. Almost all cellular detail has been obscured by the resulting shrinkage distortions. The larger cracks seen on the left of the picture may be due to dissection damage, rather than CPD. The results of observation of fresh tissue are seen in Fig. 2. Although there is a substantial improvement over CPD, some cell collapse still occurs.Due to these difficulties, it was decided to experiment with cold stage techniques. The specimens to be observed were dissected out and attached to the sample stub using a carbon based conductive paint in acetone.

HUBUNGAN KECEMASAN DAN HASIL UAS-1 MAHASISWA BARU FAKULTAS KEDOKTERAN UNIVERSITAS SAM RATULANGI MANADO TAHUN AJARAN 2012 / 2013

e-CliniC ◽  
2013 ◽  
Vol 1 (2) ◽  
Author(s):  
Daniel Alberth Lallo ◽  
L. F. Joyce Kandou ◽  
Herdy Munayang
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Coping Strategies ◽  
Significant Relationship ◽  
Odds Ratio ◽  
Rating Scale ◽  
Medical Faculty ◽  
Anxiety Level ◽  
Hamilton Anxiety Rating Scale ◽  
Almost All

Abstrak: Kecemasan dialami oleh hampir semua orang di dunia, termasuk mahasiswa baru kedokteran. Mahasiswa baru kedokteran memiliki banyak stressor termasuk ujian yang menimbulkan kecemasan dan dapat mempengaruhi hasil ujian mereka. Sampai saat ini, hanya sedikit penyelidikan yang ditemukan menyelidiki fenomena ini. Di Fakultas Kedokteran Universitas Sam Ratulangi, tidak ada yang meneliti fenomena tersebut. Penelitian ini bertujuan untuk menilai hubungan antara kecemasan dan hasil ujian semester 1 (UAS-1) mahasiswa baru program studi kedokteran umum tahun akademik 2012/2013 di Universitas Sam Ratulangi. Ini merupakan penelitian analitik potong lintang dengan metode survei dan sensus sebagai cara dalam pengambilan sampel. Sampel penelitian yang telah memenuhi kriteria inklusi dan ekslusi didapatkan berjumlah 298 orang dari 319 mahasiswa baru program studi kedokteran umum tahun akademik 2012/2013 di Universitas Sam Ratulangi. Populasi tersebut kemudian diberi informed consent, kuesioner data sosiodemografi, dan dinilai kecemasannya menggunakan Hamilton Anxiety Rating Scale (HARS). Tidak ada hubungan yang signifikan antara kecemasan dan hasil UAS-1 (p=0,602>0,05). Ada hubungan yang signifikan antara jenis kelamin dan kecemasan (p=0,005<0,05) with odds ratio 2,91. 267 dari 298 mahasiswa (89,6%) mengalami kecemasan dengan kecemasan ringan sebagai tingkat kecemasan yang paling banyak ditemukan, berjumlah 177 orang (59,4%). Semua mahasiswa baru program studi kedokteran umum tahun akademik 2012/2013 di Universitas Sam Ratulangi mengalami kecemasan, terutama kecemasan ringan. Tidak terdapat hubungan antara kecemasan dengan hasil UAS-1 mereka, tetapi terdapat hubungan antara jenis kelamin dan kecemasan dengan kecenderuang hampir 3 kali bagi mahasiswa baru perempuan untuk mengalami kecemasan dibandingkan dengan mahasiswa baru laki-laki. Dibutuhkan penelitian lebih lanjut terkait coping strategies dan defense mechanism yang dilakukan mahasiswa untuk menganggulangi kecemasan mereka. Kata Kunci: Kecemasan, Ujian, Mahasiswa kedokteran.   Abstract: Anxiety is experienced by almost all people around the world including new medical students. New medical student experiences a lot of stressor include examination which cause anxiety to occur and may affect their exam results. Somehow, there are a few study found to date that has investigate this phenomenon. In Sam Ratulangi University, which is the nearest medical faculty, there is no research for such phenomenon. This study aims to investigate the relationship between anxiety and new medical student’s achievement on their last exam in Medical Faculty of Sam Ratulangi University. This is an analytic research using a survey method with census as the option of sampling. However, the research samples are who meet inclusion category and not in the exclusion category. The nearest samples are in Sam Ratulangi University who are given questioners to measure their anxiety by using Hamilton Anxiety Rating Scale (HARS) before their exam and to collect their sosiodemograpic data as well. There is no significant relationship between anxiety and their last exam results (p=0,602>0,05), but there is a significant relationship between gender and anxiety (p=0,005<0,05) with odds ratio 2,91. According to anxiety test results, 267 of 298 grade-1 medical students (89,6%) present an anxiety and the most prevalence anxiety level is mild anxiety with total 177 people (59,4%). In conclusion, almost all grade-1 new medical students in Medical Faculty of Sam Ratulangi University experienced anxiety with mild anxiety as the most prevalence anxiety level. There is no significant relationship between anxiety and their last exam results, but there is a significant relationship between gender and anxiety with almost 3 times for new female medical students experiencing anxiety than new male medical students. Further research is needed to investigate coping strategies and defense mechanisms which may be used to cope with their anxiety. Keywords: Anxiety, Exam, Medical Student

scholarly journals Serum C-Reactive Protein Is Negatively Associated With Olfactory Identification Ability in Older Adults

i-Perception ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 204166952110099
Author(s):  
Ingrid Ekström ◽  
Davide Liborio Vetrano ◽  
Goran Papenberg ◽  
Erika J. Laukka
Keyword(s):  
Statistical Significance ◽  
Population Based ◽  
Rate Of Change ◽  
Odor Identification ◽  
Sensitivity Analyses ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Olfactory Identification ◽  
Olfactory Ability ◽  
Serum Crp

Importance Olfactory deficits are common in aging and associated with several conditions linked to inflammation. A few studies suggest that increased concentration of pro-inflammatory biomarkers may be related to olfactory deficits, but these associations are understudied in population-based samples. Objective To investigate the association between serum concentrations of C-reactive protein (CRP) and olfactory identification level as well as rate of change in aging. Methods We included 1,721 participants (mean age 70.5 years; 61.9% female) with at least two olfactory assessments across the 12-year follow-up. Baseline level and change in odor identification were estimated with linear mixed models as a function of CRP levels, derived from blood plasma at baseline. Results Results indicated a negative dose–response association between CRP level and odor identification scores at baseline, after adjustment for demographic, cognitive, health, and lifestyle factors. CRP levels ranging between 11 and 20 mg/L were significantly related to lower olfactory ability (β = −0.811, 95% confidence interval [CI] [−1.503 to −0.118]; p = .022). Likewise, CRP values above 20 mg/L were related to lower olfactory scores, an association that approached statistical significance (β = −0.996, 95% CI [−2.045 to 0.054]; p = .063). We found no associations between CRP and olfactory change ( ps > .368). Sensitivity analyses showed that associations between CRP and olfaction were confined to younger participants (age ≤72 years) and men ( ps < .034). Conclusions Our findings suggest a negative association between serum CRP levels and olfactory identification ability in aging that may be dependent on age and sex.

Pain relief with elastic therapeutic taping

2021 ◽  
pp. bmjspcare-2021-003381
Author(s):  
Ekta Gupta ◽  
Courtland Lee ◽  
Amy Ng ◽  
Eduardo Bruera
Keyword(s):  
Rating Scale ◽  
Symptom Burden ◽  
Substantial Improvement ◽  
Functional Mobility ◽  
Background Information ◽  
Symptom Improvement ◽  
Plantar Surface ◽  
Pain Rating Scale ◽  
Pain Improvement

Background and purposeChemotherapy-induced peripheral neuropathy (CIPN) occurs in 19%–85% of patients undergoing cancer treatment. Due to the high symptom burden, specifically pain in the soles of feet, we explore the role of elastic therapeutic (ET) taping for treatment of CIPN.Case descriptionWe report two cases of patients with CIPN-induced foot pain while admitted to the hospital. Their background information, including chemotherapy history, treatments trialed and effects of ET on their pain, is discussed. Each patient underwent ET using the epidermis, dermis, fascia technique for CIPN. An occupational therapist applied ET to the plantar surface of both feet to the ankle with 0% stretch on the tape for 24–96 hours. We also showed the effect of symptom improvement in their individualized rehabilitation session following application of ET.OutcomesPain score, verbally documented by 10 point numerical pain rating scale, decreased by >50% in both patients within 24 hours of application. This reflects a substantial improvement in pain with the intervention of ET. This allowed for improved tolerance in engaging in functional mobility, with improvement in distances ambulated.DiscussionET taping of the distal leg and foot showed pain improvement for these two patients. Our findings suggest that a clinical trial aimed at better characterising the role of ET in these patients is justified.

Comparative Efficacy and Safety of Sertraline Versus Nortriptyline in Major Depression in Patients 70 and Older

1999 ◽  
Vol 11 (1) ◽  
pp. 85-99 ◽  
Author(s):  
Sanford I. Finkel ◽  
Ellen M. Richter ◽  
Cathryn M. Clary
Keyword(s):  
Major Depression ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Change Score ◽  
Attrition Rate ◽  
Double Blind ◽  
Almost All ◽  
Positive Effect ◽  
Population Segment

Background. Few randomized, double-blind studies that examine antidepressant treatment in patients 70 years and older are available. To provide additional data on the safety and efficacy of antidepressants in this rapidly growing population segment, a subgroup analysis of a larger sertraline vs. nortriptyline elderly depression treatment study was performed. Methods. Outpatients (N = 76) who met DSM-III-R criteria for major depression with a minimum Hamilton Depression Rating Scale (HAM-D) severity score of 18 were randomized to 12 weeks of flexible dose treatment with sertraline (50–150 mg) or nortriptyline (25–100 mg). Results. Both treatments significantly improved depression as measured by the HAM-D and Clinical Global Impression scales. At Weeks 10, 12, and endpoint, sertraline demonstrated a significantly greater reduction in depression severity compared to nortriptyline as measured by improvement on the 24-item HAM-D (mean adjusted change score of 14.8 vs. 7.6, respectively, at Week 12; p = .001). Sixty-five percent of sertraline-treated patients were responders by Week 12 (50% or greater reduction from baseline in 24-item HAM-D score) compared to 26% of nortriptyline-treated patients (p < .05). Sertraline treatment had a significantly more positive effect, when compared to nortriptyline, across almost all associated measures of cognitive function, energy, anxiety, and quality of life and was better tolerated than nortriptyline, with a lower attrition rate/side effect burden. Conclusion. The efficacy advantage of sertraline appeared to be even greater in this subgroup of older patients drawn from a larger treatment study of depression that included elderly individuals over the age of 60.

scholarly journals PENGARUH TERAPI JAHE (ZINGIBERS OFFICINALE ROSC.) TERHADAP PENURUNAN NYERI DISMENORHOE DI AKADEMI KEBIDANAN AIFA HUSADA MADURA

2019 ◽  
Vol 10 (1) ◽  
pp. 26-32
Author(s):  
Sylvina Rahmawati
Keyword(s):  
Rating Scale ◽  
Sampling Technique ◽  
Pain Scale ◽  
Reproductive Period ◽  
Female Students ◽  
Before And After ◽  
Post Test ◽  
Reduction Of Pain ◽  
Independent Variable ◽  
Almost All

Menstruation is a sign of reproductive period in women’s life. But for some women are not like that, there are various kinds of disorders and discomfort when menstruation, such as premenstrual syndrome, dismenorhoe. Based on preliminary studies in midwifery Academy Aifa Husada Madura on Maret 20th 2016 from 107 female students of semester 4 to 59 female students (55,1%) experienced dismenorhoe, and 48 female students (44,9%) did not experience dismenorhoe. The purpose of this study was to analyze the effect of ginger therapy toward the decreasing of dismenorhoe pain. The research methods are experiment (Experiment Research). The study design used One Group Pre-Post Test Design model and the sampling technique used accidental. Independent variable in this study was giving of ginger therapy and the dependent used variable in this study was reduction of pain scale dismenorhoe. The instrument used rating scale through observations of respondents before and after given ginger therapy. The samples were taken mostly the female students who experienced dismenorhoe in Midwifery Academy Aifa Husada Madura were 51 respondents. And the results were analyzed using wilconox test (α = 0,05). The result showed that some respondents befor giving ginger therapy were almost experiencing pain dismenorhoe were 47,1 %. While almost all respondents after given ginger therapy was experiencing of lowing pain dismenorhoe were 78,4%. Based on wicoxon statistic test found the significant value 0,00 and α = 0,05. Because of significant value < α values (0,00 < 0,05) means that Ho is rejected and Hi is accepted. So, there is the effect of ginger therapy toward the decreasing of dismenorhoe pain at Midwifery Academy Aifa Husada Madura The research should be used as a reference material as a herbal medicine to decrease dismenorhoe pain.

scholarly journals ROLE OF TAGARADI CAPSULE IN THE MANAGEMENT OF ANIDRA (INSONIA) – A CLINICAL STUDY

2020 ◽  
Vol 8 (7) ◽  
pp. 3850-3857
Author(s):  
Rajnik Jadav ◽  
Alankruta Dave ◽  
Swati Dabhi
Keyword(s):  
Rating Scale ◽  
Acute Stage ◽  
Rank Test ◽  
The People ◽  
Falling Asleep ◽  
Signed Rank Test ◽  
Hypnotic Drugs ◽  
Trial Drug ◽  
Almost All

Anidra (Insomnia) is a type of sleep disorder in which individual feels difficulty in falling asleep, staying asleep or both. In Ayurveda, Anidra is indicated as VataNanatmajaVikara by Acharya Charaka. Insomnia affects most of the people at any stage of life due to today’s stressful day to day life. Allopathic hypnotic drugs are used to treat insomnia in acute stage, but long-term use can lead to dependency and withdrawal symptoms along with other side effects. In present study a polyherbal compound Tagaradi Capsule consist extracts of Tagara, Jatamansi, ParsikaYavani, Ashwagandha, Brahmi, Shankhapushpi, Pippalimula and Sarpagandha is used to check its efficacy in the management insomnia. Aim: Role of Tagaradi capsule in the management of Anidra (Insomnia). Materials and methods: Total 33 newly diagnosed patients of age group 18 to 70 years of insomnia who were not taking any other hypnotic medicine were selected and administered 2 capsules each of 500 mg of Tagaradi compound extract along with a cup of warm milk at bedtime for 2 months. Assessment was done considering the overall improvement of sleep quality according to Pittsburgh Insomnia Rating Scale, im-provement in associated complains, relieving of anxiety according to Hamilton Anxiety rating Scale and relieving of depression according to Hamilton Depression Rating Scale. Observations: The information gathered on the basis of observations was subjected to statistical analysis. The Paired ‘t’ test was used to check the significance of objective criteria and Wilcoxon Signed Rank Test was used to check the signifi-cance to subjective criteria. Results: The results showed that the trial drug had highly significant effect on almost all the mentioned parameters of Insomnia.

scholarly journals HUBUNGAN PENGETAHUAN DENGAN KECEMASAN IBU HAMIL MENJELANG PERSALINAN PADA MASA PANDEMI COVID-19

2021 ◽  
Vol 7 (3) ◽  
pp. 426-431
Author(s):  
Riska Diana Putri ◽  
Asri Mutiara Putri ◽  
Ratna Purwaningrum
Keyword(s):  
Pregnant Women ◽  
Rating Scale ◽  
Health Workers ◽  
Negative Relationship ◽  
Cross Sectional ◽  
Significant Negative Relationship ◽  
Hamilton Anxiety Rating Scale ◽  
Almost All ◽  
Relationship Of ◽  
Hamilton Anxiety

Background Coronavirus Disease 2019 is currently a pandemic in almost all countries in the world. This pandemic outbreak can increase anxiety especially in pregnant women. One of the factors that can reduce the level of anxiety of pregnant women is knowledge. Purpose This study was conducted to find out the relationship of knowledge with the level of anxiety of pregnant women ahead of childbirth in the era of the Covid-19 pandemic. Methods The type of research used is Observational Analytics using Cross Sectional design. Respondets in this study were 59 pregnant women with a gestational age of 27-35 weeks before childbirth who checked their pregnancy to posyandu in Rajadesa Subdistrict, Ciamis Regency. The measuring instrument used is hamilton anxiety rating scale (HARS) and knowledge scale. The data was analyzed using Pearson Product Moment correlation tests. The results of this study showed a significant negative relationship of -0.635 between knowledge and anxiety levels of pregnant women ahead of childbirth with a significance (p) of 0.000. Further research can expand research samples from various regions in Indonesia so that a more comprehensive picture of anxiety in pregnant women in the era of the Covid-19 pandemic.The conclusion is that there is a significant negative relationship between knowledge and anxiety in pregnant women before delivery and most pregnant women have good knowledge and do not experience anxiety. Suggestions for health workers to be more intensive in providing counseling to pregnant women about the anxiety of pregnant women before delivery and optimizing referral services if there are complications during delivery in order to obtain appropriate action. Keyword : Covid-19 pandemic, Knowledge, Anxiety ABSTRAK Latar Belakang Coronavirus Disease 2019 saat ini menjadi pandemi hampir di seluruh negara di dunia. Wabah pandemi ini dapat meningkatkan kecemasan terutama pada ibu hamil.Salah satu faktor yang dapat mengurangi tingkat kecemasan ibu hamil adalah pengetahuan.Tujuan Penelitian ini dilakukan untuk mengetahui hubungan pengetahuan dengan tingkat kecemasan ibu hamil menjelang persalinan di era pandemi Covid-19.Metode Jenis penelitian yang digunakan adalah Analitik Observasional dengan menggunakan desain Cross Sectional. Responden dalam penelitian ini adalah 59 ibu hamil dengan usia kehamilan 27-35 mimggu yang memeriksakan kehamilannya ke posyandu di Kecamatan Rajadesa Kabupaten Ciamis. Alat ukur yang digunakan adalah Hamilton Anxiety Rating Scale (HARS) dan skala pengetahuan. Data dianalisis menggunakan uji korelasi Pearson Product Moment.Hasil penelitian ini menunjukan adanya hubungan negatif yang signifikan sebesar -0,635 antara pengetahuan dengan tingkat kecemasan ibu hamil menjelang persalinan dengan signifikansi (p) sebesar 0,000. Penelitian selanjutnya dapat memperluas sampel penelitian dari berbagai daerah di Indonesia sehingga diperoleh gambaran lebih menyeluruh tentang kecemasan pada ibu hamil di era pandemic Covid-19.Kesimpulan ada hubungan negative signifikan antara pengetahuan dengan kecemasan pada ibu hamil menjelang persalinan dan  sebagian besar ibu hamil memiliki pengetahuan baik dan tidak mengalami kecemasan.Saran bagi tenaga kesehatan agar lebih intensif dalam memberikan penyuluhan pada ibu hamil mengenai kecemasan ibu hamil menjelang persalinan dan mengoptimalkan pelayanan rujukan bila terdapat komplikasi pada saat persalinan agar dapat memperoleh tindakan yang tepat Kata Kunci : Pandemi Covid-19, Pengetahuan, Kecemasan

scholarly journals Self-Ratings of Olfactory Function and Their Relation to Olfactory Test Scores. A Data Science-Based Analysis in Patients with Nasal Polyposis

2021 ◽  
Vol 11 (16) ◽  
pp. 7279
Author(s):  
Jörn Lötsch ◽  
Constantin A. Hintschich ◽  
Petros Petridis ◽  
Jürgen Pade ◽  
Thomas Hummel
Keyword(s):  
Nasal Polyposis ◽  
Rating Scales ◽  
Rating Scale ◽  
Olfactory Function ◽  
Test Battery ◽  
Clinical Test ◽  
Olfactory Test ◽  
Olfactory Testing ◽  
Numerical Rating ◽  
Self Assessments

Olfactory self-assessments have been analyzed with often negative but also positive conclusions about their usefulness as a surrogate for sensory olfactory testing. Patients with nasal polyposis have been highlighted as a well-predisposed group for reliable self-assessment. In a prospective cohort of n = 156 nasal polyposis patients, olfactory threshold, odor discrimination, and odor identification were tested using the “Sniffin’ Sticks” test battery, along with self-assessments of olfactory acuity on a numerical rating scale with seven named items or on a 10-point scale with only the extremes named. Apparent highly significant correlations in the complete cohort proved to reflect the group differences in olfactory diagnoses of anosmia (n = 65), hyposmia (n = 74), and normosmia (n = 17), more than the true correlations of self-ratings with olfactory test results, which were mostly very weak. The olfactory self-ratings correlated with a quality of life score, however, only weakly. By contrast, olfactory self-ratings proved as informative in assigning the categorical olfactory diagnosis. Using an olfactory diagnostic instrument, which consists of a mapping rule of two numerical rating scales of one’s olfactory function to the olfactory functional diagnosis based on the “Sniffin’ Sticks” clinical test battery, the diagnoses of anosmia, hyposmia, or normosmia could be derived from the self-ratings at a satisfactorily balanced accuracy of about 80%. It remains to be seen whether this approach of translating self-assessments into olfactory diagnoses of anosmia, hyposmia, and normosmia can be generalized to other clinical cohorts in which olfaction plays a role.

scholarly journals Contextualizing SEGUE: Evaluating Residents' Communication Skills Within the Framework of a Structured Medical Interview

2010 ◽  
Vol 2 (1) ◽  
pp. 102-107 ◽  
Author(s):  
Jared Lyon Skillings ◽  
John H. Porcerelli ◽  
Tsveti Markova
Keyword(s):  
Communication Skills ◽  
Rating Scale ◽  
Substantial Improvement ◽  
Resident Training ◽  
New Method ◽  
Medical Interview ◽  
Case Examples ◽  
New Instrument ◽  
Medical Interviews ◽  
Global Ratings

Abstract Background The SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, and End the encounter) Framework is a checklist-style rating scale to facilitate the teaching and assessment of communication skills in medical learners. It has been used for over 15 years, and it is recommended in the Accreditation Council for Graduate Medical Education toolbox of assessment methods for resident training. When it was developed, its ability to provide objective scoring was a substantial improvement over global ratings. Methods In this article we describe the strengths and weaknesses of the SEGUE Framework. We highlight one residency program's experience with using the SEGUE Framework to evaluate residents' communication skills. Specifically, we cite previous studies and describe our own analysis of resident interviewing performance that demonstrates how the SEGUE Framework did not distinguish between different levels of interviewing skill level in our sample. Results Two case examples illustrate how the SEGUE Framework is not an ideal instrument to measure either the quality or the process of medical interviews. Conclusion Therefore, we propose a new method of contextualized assessment that builds on the SEGUE Framework. Our system evaluates discrete interviewing behaviors within the context of an ambulatory medical interview. We describe our interview structure, as well as a new instrument (the Wy-Mii, pronounced “why me”), to assess both communication and interpersonal skills. We expect that our new method of contextualized assessment will better differentiate between beginning and advanced levels of medical interviewing skills for residents.

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