Are patients' and doctors' accounts of the first specialist consultation for chronic back pain in agreement?

INTRODUCTION: The first consultation at a specialist pain clinic is potentially a pivotal event in a patient’s pain history, affecting treatment adherence and engagement with longer term self-management. What doctors communicate to patients about their chronic pain and how patients interpret doctors’ messages and explanations in pain consultations are under-investigated, particularly in specialist care. Yet, patients value personalized information about their pain problem. PATIENTS AND METHODS: Sixteen patients in their first specialist pain clinic consultation and the doctors they consulted were interviewed shortly after the consultation. Framework analysis, using patient themes, was used to identify full match, partial match, or mismatch of patient–doctor dyads’ understandings of the consultation messages. RESULTS: Patients and doctors agreed, mainly implicitly, that medical treatment aiming at pain relief was primary and little time was devoted to discussion of self-management. Clinically relevant areas of mismatch included the explanation of pain, the likelihood of medical treatments providing relief, the long-term treatment plan, and the extent to which patients were expected to be active in achieving treatment goals. DISCUSSION: Overall, there appears to be reasonable concordance between doctors and patients, and patients were generally satisfied with their first consultation with a specialist. Two topics showed substantial mismatch, the estimated likely outcome of the next planned intervention and, assuming (as doctors but not patients did) that this was unsuccessful, the long-term treatment plan. It appeared that more complex issues often generate divergence of understanding or agreement. Despite the widespread recommendations to medical practitioners to check patients’ understanding directly, it does not appear to be routine practice. CONCLUSION: It is hoped that this research encourages more detailed examination of shared and divergent experiences of pain consultations and also their influence on the subsequent course of intervention and adherence to treatment (not addressed here)

How do patients and doctors make sense of chronic back pain in the first specialist consultation?

Aim: This paper aimed to examine how patients with chronic back pain understand and experience the messages about pain and treatment in their first specialist medical (pain clinic) consultation. It also aimed to compare what doctors believe they communicated with patients’ own ‘take home’ messages. Method: Sixteen patients were interviewed immediately after their first consultation at a pain clinic, and their corresponding doctors were interviewed shortly afterwards. Thematic analysis was conducted on the patient interviews to address the first research aim, and then framework analysis was employed to compare understandings of the consultation within the patient-doctor dyads. Results: Thematic analysis of patient interviews resulted in four higher-order themes: the central role of medical treatments in the treatment of pain; a dilemma about hoping when there are ‘no guarantees’; the importance of trying all recommended medical interventions and, for a minority of patients, relief to be recommended non-medical pain management. Although there was considerable overlap within the patient-doctor dyads, clinically relevant areas of mismatch included the explanation of pain, the likely long-term treatment plan, and patients’ role in their treatment. Conclusions: Patients’ understandings of the consultation messages seemed to influence their beliefs about the likelihood of their pain being relieved, and their sense of control over it. There seemed notable areas of mismatch between doctors’ and patients’ understandings of the consultation which are likely to impact upon treatment success and patient satisfaction

Efficient coupling into slow light photonic crystal waveguide without transition region: Role of evanescent modes

We show that efficient coupling between fast and slow photonic crystal waveguide modes is possible, provided that there exist strong evanescent modes to match the waveguide fields across the interface. Evanescent modes are required when the propagating modes have substantially different modal fields, which occurs, for example, when coupling an index-guided mode and a gap-guided mode. ©2009 Optical Society of America

Efficient slow-light coupling in a photonic crystal waveguide without transition region

We consider the coupling into a slow mode that appears near an inflection point in the band structure of a photonic crystal waveguide. Remarkably, the coupling into this slow mode, which has a group index ng > 1000, can be essentially perfect without any transition region. We show that this efficient coupling occurs thanks to an evanescent mode in the slow medium, which has appreciable amplitude and helps satisfy the boundary conditions but does not transport any energy. © 2008 Optical Society of America

Eye movements during reading and topic scanning: effects of word frequency

The study examined the nature of eye movement control and word recognition during scanning for a specific topic, compared with reading for comprehension. Experimental trials included a manipulation of word frequency: the critical word was frequent (and orthographically familiar) or infrequent (2 conditions: orthographically familiar and orthographically unfamiliar). First-pass reading times showed effects of word frequency for both reading and scanning, with no interactions between word characteristics and task. Therefore, in contrast to the task of searching for a single specific word (Rayner and Fischer, 1996), there were immediate and localized influences of lexical processing when scanning for a specific topic, indicating that early word recognition processes are similar during reading and topic scanning. In contrast, there were interactions for later measures, with larger effects of word frequency during reading than scanning, indicating that reading goals can modulate later processes such as the integration of words into sentence context. Additional analyses of the distribution of first-pass single fixation durations indicated that first-pass fixations of all durations were shortened during scanning compared with reading, and reading for comprehension produced a larger subset of longer first-pass fixations compared with scanning. The implications for the nature of word recognition and eye movement control are discussed

artcat: Sample-size calculation for an ordered categorical outcome

We describe a new command, artcat, that calculates sample size or power for a randomized controlled trial or similar experiment with an ordered categorical outcome, where analysis is by the proportional-odds model. artcat implements the method of Whitehead (1993, Statistics in Medicine 12: 2257–2271). We also propose and implement a new method that 1) allows the user to specify a treatment effect that does not obey the proportional-odds assumption, 2) offers greater accuracy for large treatment effects, and 3) allows for noninferiority trials. We illustrate the command and explore the value of an ordered categorical outcome over a binary outcome in various settings. We show by simulation that the methods perform well and that the new method is more accurate than Whitehead’s method

Effects of aging, word frequency, and text stimulus quality on reading across the adult lifespan: evidence from eye movements

Reductions in stimulus quality may disrupt the reading performance of older adults more when compared with young adults because of sensory declines that begin early in middle age. However, few studies have investigated adult age differences in the effects of stimulus quality on reading, and none have examined how this affects lexical processing and eye movement control. Accordingly, we report two experiments that examine the effects of reduced stimulus quality on the eye movements of young (18-24 years), middle-aged (41-51 years), and older (65 years) adult readers. In Experiment 1, participants read sentences that contained a high-or low-frequency critical word and that were presented normally or with contrast reduced so that words appeared faint. Experiment 2 further investigated effects of reduced stimulus quality using a gaze-contingent technique to present upcoming text normally or with contrast reduced. Typical patterns of age-related reading difficulty (e.g., slower reading, more regressions) were observed in both experiments. In addition, eye movements were disrupted more for older than younger adults when all text (Experiment 1) or just upcoming text (Experiment 2) appeared faint. Moreover, there was an interaction between stimulus quality and word frequency (Experiment 1), such that readers fixated faint low-frequency words for disproportionately longer. Crucially, this effect was similar across all age groups. Thus, although older readers suffer more from reduced stimulus quality, this additional difficulty primarily affects their visual processing of text. These findings have important implications for understanding the role of stimulus quality on reading behavior across the lifespan

Effects of adult aging on letter position coding in reading: evidence from eye movements

It is well-established that young adults encode letter position flexibly during natural reading. However, given the visual changes that occur with normal aging, it is important to establish whether letter position coding is equivalent across adulthood. In 2 experiments, young (18-25 years) and older (65 years) adults' were recorded while reading sentences with words containing transposed adjacent letters. Transpositions occurred at beginning (rpoblem), internal (porblem), or end (problme) locations in words. In Experiment 1, these transpositions were present throughout reading. By comparison, Experiment 2 used a gaze-contingent paradigm such that once the reader's gaze moved past a word containing a transposition, this word was shown correctly and did not subsequently change. Both age groups showed normal levels of comprehension for text including words with transposed letters. The pattern of letter transposition effects on eye movements was similar for the young and older adults, with greater increases in reading times when external relative to internal letters were transposed. In Experiment 1, however, effects of word beginning transpositions during rereading were larger for the older adults. In Experiment 2 there were no interactions, confirming that letter position coding is similar for both age groups at least during first-pass processing of words. These findings show that flexibility in letter position encoding during the initial processing of words is preserved across adulthood, although the interaction effect in rereading in Experiment 1 also suggests that older readers may use more stringent postlexical verification processes, for which the accuracy of word beginning letters is especially important

artbin: Extended sample size for randomized trials with binary outcomes

We describe the command artbin, which offers various new facilities for the calculation of sample size for binary outcome variables that are not otherwise available in Stata. While artbin has been available since 2004, it has not been previously described in the Stata Journal. artbin has been recently updated to include new options for different statistical tests, methods and study designs, improved syntax, and better handling of noninferiority trials. In this article, we describe the updated version of artbin and detail the various formulas used within artbin in different settings