Objectives To translate the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) to the European Portuguese spoken language and to verify its reliability and validity. Methods Cultural adaptation and linguistic translation from English to European Portuguese, revision of translations, semantics equivalence, and grammar correction of the Portuguese wording were made. Readability of the Portuguese version was verified and the analysis of internal consistency and correlation with the subscale “physician–patient relationship” of the Portuguese version of European Task Force on Patient Evaluation of General Practice Care Scale (EuroPEP) were made. Reliability was tested by intertemporal stability and internal consistency. Validity of criteria and construction was also verified. Results The Portuguese translation was adapted to the 8th or 9th grade level, easy to understand. There was the need to change the visual appearance of the scale, answers below sentences. Interclass correlation coefficient for reliability varied between 0.737 and 1.000 and Cronbach’s α between 0.806 and 0.877. Validity was verified by comparing values of socio-demographic variables for JSPPPE index and for EuroPEP with no differences. Correlation values between the total score and its five items varied from 0.806 to 0.934. Criterion validity against EuroPEP had a correlation of 0.831. Conclusion This study fulfilled the necessary steps to translate, verify the validity and the reliability of the Portuguese version of the JSPPPE, with minimum layout alteration. All five items were maintained. The authors recommend the use of the JSPPPE in research and clinical practice.
Presentation and diagnosis A 62-years old male was brought to the emergency department after being found unconscious, lying on his left side. He was last seen 1 week before. Past medical history revealed ischemic cardiomyopathy with reduced ejection fraction of 35% after ST-segment elevation myocardial infarction 3 months before, subject to coronary angioplasty of 2 vessels (left anterior descending artery with drug-eluting stent and circumflex artery with balloon angioplasty). He had poor therapeutic compliance with missing cardiology appointments. On examination, he was hypothermic and hemodynamically unstable with signs of hypoperfusion. He was admitted for septic shock with origin in a decubitus ulcer on his left-hand dorsum. Head CT-scan revealed sub-acute ischemic stroke in the right middle cerebral artery territory. He started fluid therapy, vasopressors and large spectrum antibiotics with favorable clinical evolution and no heart failure symptoms but remained febrile. Meanwhile, Proteus hauseri had grown in blood cultures. An echocardiography was performed excluding infectious endocarditis and revealing a large apical thrombus on the left ventricle. Management Therapeutic anticoagulation with enoxaparin was initiated and antibiotic was de-escalated according to the antibiogram. Later on, anticoagulation was switched to warfarin (target INR∼2.0–3.0). When clinically stable, was discharged home with anticoagulation and clopidogrel, with an echocardiography scheduled after 3 months. Learning points Left ventricular thrombus is a rare complication of ischemic cardiomyopathy with high risk of adverse outcomes, including ischemic stroke and death. Vitamin K antagonists are usually preferred to direct oral anticoagulants in the management of these patients, but further research is needed.
AMBIVALENCE(S) OF ADOLESCENCE AND THE ROLE OF THE FAMILY PHYSICIAN: A CASE REPORTIntroduction: The family physician (FF) besides being able to address the most prevalent problems of adolescence, should also promote the active and responsible participation of the adolescence in health matters, based on their individualized intervention and confidentiality. The awareness of sexual orientation in the case of homosexuality usually arises during adolescence and it might involve a period of confusion and doubt. Discrimination and associated stereotypes still mark a lot of those who are confronted with their sexual orientation. Case report: Male, 16 years, presented to the consult after some concern of his mother for isolation, sadness, and fear of serious psychological problems with her child. During the well known HEEADSSS acronym assessment, the question arises about his own sexuality admitting to being homosexual, with innumerable fears, ambivalences, and shame about this, that have led him to move away from the family, group of friends and colleagues. Doubts about the future in school and profession also leave him worried and feeling alone in a world he does not identify himself with. Active listening and confidentiality, the demystification of some themes and availability for consultations, as well as referral to psychologists are part of the joint plan, which is maintained, with frank improvement. Commentary: Doubts about sexual orientation can be devastating in the teenage years, conditioning isolation, self-blame, and shame. The FF occupies a privileged position in the early detection and clarification of issues related to sexuality, thus allowing a healthy growth, physical, psychological and socially.
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