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Background The Patient Perception of Patient-Centeredness (PPPC) questionnaire was revised, and there is a need for the questionnaire to be tested in diverse primary care populations. Objectives This study aimed to examine the factor structure of the Revised PPPC questionnaire (PPPC-R) in French-speaking patients with multimorbidity. Design Secondary analysis from baseline data of the French arm of Patient-Centered Innovations for Persons with Multimorbidity Study (PACEinMM Study). Setting and participants Participants were adult patients with multimorbidity attending primary health-care settings. Outcome measures Exploratory factor analyses were applied to examine the factor structure of the PPPC-R. Cronbach's alpha values were calculated to assess the internal consistency of the whole questionnaire and of each factor explored. Results There were 301 participants, mean age 61.0, 53.2% female. The PPPC-R showed very good internal consistency, with three factors: Patient-Centered Clinical Method (PCCM) Component 1-Exploring the health, disease and illness experience + PCCM Component 4-Enhancing the patient-clinician relationship (Factor 1); PCCM Component 2-Understanding the whole person (Factor 2); and PCCM Component 3-Finding common ground (Factor 3). There was a good internal consistency within each factor (Cronbach's α = 0.87 for 8 items in Factor 1, 0.77 for 5 items in Factor 2 and 0.87 for 5 items in Factor 3). Discussion and conclusions The French PPPC-R factor structure was in accordance with the underpinning conceptual model and presented with three factors. Further assessment of its validity and reproducibility are needed to allow its use as a measure of patient's perception of patient-centeredness.

Background The ideal gentle cleansing product is one that effectively removes soils while minimizing damage to the skin. Thus, measuring physical abrasion caused by cleansing tissues is critical to the continued development of gentle cleansing products. Current analysis of cleansing materials for skin gentleness is time consuming and requires expensive human subject testing. This report describes the development of a rapid and inexpensive bench assay for the assessment of skin abrasion caused by wiping. Methods Coefficient of friction (COF) evaluations using bench methods were compared with results from clinical studies of repeated wiping and with confocal visualizations of excised skin. A Monitor/Slip and Friction™ instrument (model 32-06; TMI, Amityville, NY, USA) was used to measure tissue friction on simulated skin (Vitro-Skin®, N19-5X; IMS, Milford, CT, USA). Clinical data from a 4-day repetitive forearm wiping study measuring transepidermal water loss (TEWL) in 30 subjects was compared with results from the bench top assay. In addition, excised skin samples were also treated using the COF bench assay and examined using confocal microscopy to visualize stratum corneum damage caused by wiping. Results Using the bench COF assay, we were able to distinguish between bath tissue codes by comparing average static friction value (ASFV) for the test codes, where lower ASFV indicated less abrasive tissue. The ASFV followed the same gentleness trend observed in the clinical study. Confocal microscopy of excised skin wiped with the same materials indicated stratum corneum damage consistent with the bench COF and clinical TEWL observations. Conclusion We observed significant correlation between bench and clinical methods for measuring skin damage caused by wiping of skin with tissue. The bench method will facilitate rapid and inexpensive skin gentleness assessment of cleansing materials.

There is now an extensive and highly developed literature within psychoanalysis on how best to understand the patients we work with, and their impact on the analyst or therapist, but far less on the mind of the clinician and how he or she thinks while working with the patient. One method for studying this, the Comparative Clinical Method developed by a group of European psychoanalysts, consists of a two step model: after a careful description of the interventions made by the analyst, an attempt is made to construct what is taken to be the analyst’s implicit working model, the internal template which he or she tacitly employs to conduct the analysis. In this paper I describe this model, which I then illustrate by taking a piece of published clinical material to show what an approach based on the Comparative Clinical Method might look like. Finally I make some comments on applying this model to the work of psychoanalytic psychotherapists.

This essay differentiates ways the word ‘psychoanalysis’ has been used. Freud's (1912) clinical method required analysts' ‘evenly suspended attention’ and patients' ‘free associations’. Importantly, the direct application of prior knowledge, in the clinical situation, is regarded as an impediment to understanding for both analyst and patient as such ‘knowledge’ may support intellectual, obsessional defences against overwhelming emotional experiences. Frequent sessions over a long time are therefore required in order to understand patients' defences and the anxieties and affective states which led to their creation. The need to discover anew each patient's emotional states as they are lived in the transference–countertransference relationship may be impaired by recourse to prior knowledge. The optimal employment of this method is subject to limitations, however, imposed by a variety of factors, internal and external, to both analysts and patients. Freud (1919), recognizing this, acknowledged that the discoveries made by psychoanalysts undertaking ‘unalloyed’ analysis had created a body of prior knowledge which might be legitimately used therapeutically to undertake modified treatments of a more directive kind. Unalloyed analysis might need to be combined with ‘the copper of suggestion’ to provide ‘applied’ analytically informed treatments more widely than would otherwise be the case, for example, less frequently. However, having used the word ‘psychoanalysis’ to describe both unalloyed analysis and analysis alloyed, Freud also used the term in a polemical manner and as a kind of ‘brand-name’. This paper confines itself to these rather different uses Freud made of the term psychoanalysis often without distinction, and the confusions and contradictions which have arisen as a result. These different uses may be largely uncommented upon but have exerted, and continue to exert, an important influence upon both the historical and contemporary analytic discourse.

Bruxism is a much-discussed clinical issue in dentistry. Although bruxism is not a life-threatening disorder, it can influence the quality of human life, especially through dental problems, such as tooth wear, frequent fractures of dental restorations and pain in the oro-facial region. Therefore, various clinical methods have been devised to assess bruxism over the last 70 years. This paper reviews the assessment of bruxism, provides information on various assessment methods which are available in clinical situations and discusses their effectiveness and usefulness. Currently, there is no definitive method for assessing bruxism clinically that has reasonable diagnostic and technical validity, affects therapeutic decisions and is cost effective. One future direction is to refine questionnaire items and clinical examination because they are the easiest to apply in everyday practice. Another possible direction is to establish a method that can measure actual bruxism activity directly using a device that can be applied to patients routinely. More clinical studies should examine the clinical impact of bruxism on oral structures, treatment success and the factors influencing the decision-making process in dental treatment.

The technique of metacarpal radiogrammetry was devised in 1960 as a clinical method to aid in the identification of thinned cortical bone, which may help in diagnosis of osteoporosis. Through taking measurements from radiographs, calculations of the amount of cortical bone can be made. The technique is relatively simple and is not destructive. This paper examines the value of the application of this technique to archaeological remains. A standardized methodology of bone assessment is incorporated to enhance the comparability of future research. Statistical tests demonstrate that the technique is robust, as the position of the bone on the film, radiographic enlargement and use of either the left or right metacarpal will not affect the results obtained. However, differences in film type and measurement position can introduce unacceptable variance into the results. Therefore, guidance is given on future applications of the technique. The technique does have value as a widely available, non-destructive technique for assessing cortical bone loss and the probable prevalence of osteoporosis in archaeological collections. Copyright © 2004 John Wiley & Sons, Ltd.

The continuous intrathecal infusion of drugs with implantable and programmable pumps is commonly used for the treatment of otherwise intractable pain and spasticity. There is now a consensus that it is possible to use mixtures of two or even three drugs in selected cases. The calculation of the parameters of the pump is easy for a single drug, but it becomes more complicated for a combination of two or three drugs. This paper offers some algebraic formulae that make easier and faster the calculation of the following values: the flow of the pump, the volume of each drug solution to be added to the final mixture, the concentration of each drug in the mixture and the duration of the infusion. These values are determined from the desired quantity of each drug to be infused in 24h, the concentration of each drug solution and the volume of the reservoir. It is essential that the drugs do not react with one another, that they will remain stable in the reservoir at body temperature and that they are safe for a long-term infusion.

Summary. This paper demonstrates that it is feasible to teach clinical methods in general practice and describes the organization of an appropriate attachment. Willing practitioners, properly briefed, are competent to undertake clinical methods teaching and the attachment provides satisfaction to both students and teachers. It is possible to provide in primary care the elements which seem to be the key to this outcome — protected time, teaching in very small groups, direct observation and concentration on systematic examination rather than on particular physical signs. There is a strong case for the promoting of clinical methods teaching by general practitioners.

A new and simplified method to estimate the salivary buffer capacity was tested. The method, Dentobuff Strip, consists of a pH indicator paper that has been impregnated with acid. A small volume of saliva is added to the strip and after 5 min the color of the strip is compared with a chart. The colors have been chosen to indicate low, medium, or good buffer capacity. The buffer capacity of stimulated saliva samples from 62 subjects was measured with the new method and compared with two commonly used clinical methods, Dentobuff, and an electrometric method. The three methods correlated well, and patients with a low salivary buffer capacity (final pH less than or equal to 4), according to the electrometric method, were readily identified with the new Dentobuff Strip method.