In the community teaching, Alzheimer’s Disease was the topic chosen from Healthy People 2020. The Alzheimer’s teaching was a very good experience because it was interesting to see how many people are living with Alzheimer’s or have family and friends that have been afflicted with this terrible disease, but yet know very little about it. The medical community still doesn’t have a cure for this disease so prevention becomes paramount in the fight against it.  The teaching touched on various prevention measures that people can implement to increase their odds against this disease.

Alzheimer’s Disease is the most common type of dementia. It’s a progressive disease beginning with mild memory loss possibly leading to loss of the ability to carry on a conversation and respond to the environment. It involves parts of the brain that control thought, memory, and language. Alzheimer’s Disease can seriously affect a person’s ability to carry out daily activities. Every 65 seconds someone in the United States develops the disease. Census data suggests that the prevalence of dementia among adults aged 65 years and older in the U.S. in 2016 is 11%, or 5.2 million people. Alzheimer’s Disease is the 6th leading cause of death in the United States. The symptoms of the disease can first appear after age 60 and the risk increases with age. Increasing age is the greatest known risk factor for Alzheimer’s. Younger people may get Alzheimer’s disease, but it is less common. The number of people living with the disease doubles every 5 years beyond age 65. This number is projected to nearly triple to 14 million people by 2060. Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year. (“Dementia”, n.d) Many countries do not possess the diagnostic tools, and do not have the doctors and researchers with the expertise to diagnose this disease, therefore the number of undiagnosed patients may be substantially higher.

Between two thousand and two thousand fifteen, the deaths from Heart Disease have decreased eleven percent while deaths from Alzheimer’s have increased one hundred twenty three percent. One in three seniors dies with Alzheimer’s or other types of dementia. This disease kills more than breast cancer and prostate cancer put together. The earlier this disease is diagnosed the more lives that could be saved. It is estimated that seven point nine trillion dollars in medical and care cost and be saved. In twenty eighteen Alzheimer’s and other types of dementias will cost the American people two hundred seventy seven billion by twenty fifty. It is possible for this cost to rise as high as one point one trillion dollars. (Facts and Figures, n.d)

Alzheimer Disease was named after Dr. Alois Alzheimer. Which in 1906, he noticed changes in the brain tissue of a woman who had died of an unusual mental illness. The women exhibited symptoms included memory loss, language problems, and unpredictable behavior. After she pasted away, Dr. Alzheimer examined her brain and found some abnormal clumps and tangled bundles of fibers. These clumps are now called amyloid plaques. Amyloid plaques and tangles in the brain are still considered some of the main features of Alzheimer’s disease. As Scientists continue to unravel this complex brain change involved with the onset and progression of Alzheimer’s disease, what has been learnt is that it appears that the damage to the brain starts decades or more before memory and other cognitive problems appear. As more neurons are destroyed, other parts of the brain start becoming affected, which causes them to begin to shrink. The final stage of Alzheimer’s damage is widespread, and brain tissue has shrunk significantly. (Alzheimer’s Disease Fact Sheet, n.d)

“Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer’s disease. The first symptoms of Alzheimer’s vary from person to person. For many, decline in non-memory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment, may signal the very early stages of Alzheimer’s disease”. (“Alzheimer’s Disease Fact Sheet”, n.d)

Alzheimer’s has three distinct stages mild, moderate and severe and also referred to early, middle and late stages. During the mild stage of Alzheimer’s, disease progresses and people experience greater memory loss and other cognitive difficulties. Some of the problems that manifest are wandering and getting lost, repeating questions, and taking longer to complete normal daily tasks. During the mild stage of Alzheimer is usually when people are diagnosed. During the moderate stage, damage starts occurring in different parts of the brain that control language, reasoning, sensory processing, and conscious thought. Memory loss and confusion can become worse, and people can even begin to have problems recognizing family and friends. Ultimately, things continue to get worse in the severe stage as plaques and tangles spread throughout various parts of the brain, and the brain tissue shrinks significantly. Once a person develops severe Alzheimer’s they cannot communicate and are completely dependent on others for individual care. (Alzheimer’s Disease Fact Sheet, n.d)

Alzheimer’s disease is very complex, so it is unlikely that any one drug or intervention can successfully provide treatment. Currently, approaches tend to focus on helping people maintain mental function, manage behavioral symptoms, and slow down certain problems, such as memory loss. There are several medications for maintaining mental function approved by the U.S. Food and Drug Administration (FDA) to treat symptoms of Alzheimer’s. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) are used to treat mild to moderate Alzheimer’s, (donepezil can be used for severe Alzheimer’s as well). Memantine (Namenda) is used to treat moderate to severe Alzheimer’s. These drugs work by regulating neurotransmitters, the chemicals that transmit messages between neurons. They may help reduce symptoms and help with certain behavioral problems. However, these drugs don’t change the underlying disease process. (Alzheimer’s Disease Fact Sheet, n.d)

Some additional options include keeping a safe environment by removing unnecessary furniture, clutter and throw rug in the home. Make sure all handrails on stairways and in bathroom are sturdy. Verify that shoes and slippers are comfortable and provide good traction. “The caregivers can provide high calorie, healthy shakes and smoothies to satisfy nutrition requirements. Exercise can also promote restful sleep and prevent constipation since activities help improve mood and maintain health of joints and muscles”. (Alzheimer’s Disease Fact Sheet, n.d)

My teaching is to educate Elderly- Adults (50 years of age and older) with higher risk of Alzheimer’s disease the information available to them in accordance to the Healthy People 2020 objectives. Based on the data available at Healthy People 2020, at baseline, 34.8 percent of adults aged 65 or over with a dementia diagnosis, or their caregiver, were aware of the dementia diagnosis in 2007–09. The target is 38.3 percent, based on a target-setting method of 10 percent improvement. To achieve progress towards this, actions include ensuring that both the public and health care providers are aware of the early warning signs of Alzheimer’s dementia; educating health care providers on early detection and diagnosis, including patient/family communications and documentation in medical records; and assessing cognition during the Medicare Annual Wellness Visit (AWV). (Dementias, Including Alzheimer’s, n.d)

The community response to the teaching was positive but it is important to remember Dementia is a rapidly growing problem in all parts of the developing world. Many of these societies are characterized by low levels of awareness regarding this disease as a chronic degenerative brain syndrome. They often have a lack of supportive health and welfare services. People with this affliction will have a reliance on their families as the cornerstone of support and care. However, surprisingly little is known of the care that is arranged for the people with dementia and the strain experienced by the family and caregivers.  In a study of seventy caregivers of people with Alzheimer’s disease identified through an innovative case-finding program in five different community in Indo-Nepal Border, information obtained from the range of care arrangements, attitudes towards care giving roles and sources of the strain that care givers are experiencing. It was found that the majority of caregivers were young women, often the daughters-in-law of women with dementia.

I have many areas of strengths and defiantly have some areas that I can improvement for my next presentation. I often find my speech delivery is one of my weaknesses as I speak to the crowd. Although I am usually able to maintain a lively voice and keep people engaged but I struggle to stand still. I also find myself not making enough eye contact with my audience. No matter how much I try to stop myself, I always find myself fidgeting. Some of my strengths are arranging and delivery. I present the material in a well-organized fashion. I structure my speeches so that I can thoroughly explain my thoughts with my introduction, body, and conclusion. I always like to ensure that my audience has a full understanding of the point that I am making. I also make sure my audience know the reasoning behind every individual point. I also like to explaining and reiterating my thoughts to ensure that the audience can fully understand what I am saying. My delivery often has several positive aspects. Although, I would not consider myself a monotone speaker, I always make sure to have some inflection and excitement when I am delivering my speech. This makes the topic seem more interesting to the listeners and keeps them engaged.

In conclusion, I find this entire experience of creating a pamphlet and the community teaching to be very satisfying. I became a nurse to help people that are suffering from various ailments find some kind of relief. Teaching the elderly about different aspects of a disease which in turn will allow them to make better healthy choices is as good as it gets. After my presentation, many of the attendees personally addressed me with praises for taking the time out to educate them on this topic.

References

• 10 Early Signs and Symptoms of Alzheimer’s. (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/10_signs
• Alzheimer’s Disease and Healthy Aging. (2018, October 02). Retrieved from https://www.cdc.gov/aging/index.html
• Alzheimer’s Disease Fact Sheet. (n.d.). Retrieved from https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
• Dementia. (n.d.). Retrieved from http://www.who.int/en/news-room/fact-sheets/detail/dementia
• Dementias, Including Alzheimer’s Disease. (n.d.). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/dementias-including-alzheimers-disease
• Facts and Figures. (n.d.). Retrieved from https://www.alz.org/alzheimers-dementia/facts-figures

ORIGINAL RESEARCH ARTICLE

‘THE ACCEPTANCE AND USE OF JARGONS IN CASE HISTORY TAKING: A CROSS SECTIONAL QUESTIONNAIRE BASED STUDY AMONG CLINICAL DENTAL STUDENTS AND FACULTY MEMBERS OF DENTAL COLLEGES IN ERNAKULAM AND IDUKKI DISTRICTS, KERALA, INDIA’

ABSTRACT

Background:

The use of jargons has become very common in health care field, especially in medical/dental records. Although use of standard medical jargons, can be seen as professional, efficient shorthand, the lack of awareness regarding the standard medical abbreviations and incessant and overzealous use of slangs among the health care professionals can act as a barrier in effective communication and understanding among patients and peers.

Objective:

To assess the acceptance and use of jargons in case history taking among clinical dental students and dental teaching faculty members of dental colleges in Ernakulam and Idukki districts of Kerala.

Methodology:

A cross-sectional questionnaire based survey containing 15 questions to assess the objective of the study was done. The study was conducted among clinical dental undergraduate students, house surgeons, post graduate students and teaching faculty members of five dental colleges in Ernakulam and Idukki districts, Kerala. Results were expressed as a number and percentage of response for each question and Chi-square test was performed for inferential statistical analysis.

Results:

All the 549 respondents used jargons in case history taking. About 22.4% of the respondents admitted that they always used jargons and 55.8 % admitted of using jargons only when there was a lack of time. Majority of the respondents (71.4%) learnt the jargons from their colleagues. About 50% of respondents admitted of using jargons in history section and about 32% of the respondents in all sections of case history taking. About 74% were of the opinion that abbreviations should be permitted in case history taking.

Conclusion:

This study points out that there is a widespread use of jargons/abbreviations in case history taking among the respondents. There is a lack of knowledge regarding standard medical abbreviations. Although majority of the respondents are comfortable with the use of jargons, majority of the postgraduates and faculty feel the use of jargons should be stopped.

Keywords:

Jargon, abbreviations, case history, dental students

INTRODUCTION

Jargon is defined as “the language, esp. thevocabulary, peculiar to a particular trade, profession, or group; medical jargon, plumber’s jargon” All professions use this linguistic shorthand that serves as a means of communication among members but effectively excludes all others(1). It is very useful in a community sharing a common interest as it removes much information redundancy.At the same time, it represents a barrier to those unfamiliar with it.(2) Communication failures created by jargon are especially plentiful and pernicious in healthcare.

Medical/dental records consist of information kept by doctors, health care centres, community health clinics or local hospitals detailing what the doctors or other bodies know about the medical condition and history of patients.(3) They consist of case history, details about medical/dental examinations, treatment planning, treatments done, medications prescribed etc.

Like every profession, the use of jargons has become very common in health care field as well, especially in medical/dental records. Although use of standard medical jargons, in its most positive light, can be seen as professional, efficient shorthand, the lack of awareness regarding the standard medical abbreviations and incessant and overzealous use of slangs, mistaking them for jargons, among the health care professions can act as barriers in effective communication and understanding among patients and peers. Moreover, communication barriers often go undetected in health care settings and can have serious effects on the health and safety of patients (4).

Hence, this study was conducted with an objective of assessing the acceptance and use of jargons in case history taking among clinical dental students and dental teaching faculty members of dental colleges in Ernakulam and Idukki districts, in Kerala.

METHODOLOGY

The study was a cross-sectional questionnaire based survey. The target population was the dental students with clinical exposure (third year and final year BDS), house surgeons, post graduate students and the teaching faculty members of five dental colleges in Ernakulam and Idukki districts of Kerala. A prefabricated validity tested questionnaire that was administered to the target population.The questionnaire was divided into two parts. The first part consisted of questions on personal and professional data including age, gender and designation. The second part contained 15 questions on the acceptance and use of jargons in dental case history taking.Two of the 15 questions were open ended. Informed consent was obtained from the respondents.

The questionnaires were distributed by the faculty members of Department of Public Health Dentistry and house surgeons posted in the department. The respondents were asked to answer and return the questionnaire immediately.

All returned questionnaires were coded and analysed. Results were expressed as number and percentage of response for each question and were analysed using the SPSS Version 17 software. Chi-square test was performed to compare the response in relation to gender and designation and the level of significance was set at

p =

0.05.

RESULTS

Respondent’s profile

Among a total of 549 respondents, 24.4% (n=134) were males. About 46.3% (n=254) were undergraduate students, 25.9% (n=142) were house surgeons, 11.3% (n=62) were students pursuing post-graduation and the rest 16.6% (n=91) were teaching faculty members. The profile of respondents is given in table 1.

Acceptance and use of jargons among respondents

The response to questions asked regarding the acceptance and use of jargons in dental case history taking are outlined in Table 2.

All the respondents used jargons in case history taking. About 22.4% of the respondents admitted that they always used jargons and 55.8 % admitted of using jargons only when there was a lack of time. About 62.6% used abbreviations as it saved time and about 49.2% used it as it was easy. Majority of the respondents (71.4%) learnt the jargons from their colleagues and 38.25% admitted of having learnt them from their teachers.

About half the number of respondents used jargons in history section and about 21%, in clinical examination. However, about 32% of the respondents used abbreviations in all sections of case history taking (personal information, history, clinical examination, diagnosis and treatment). Although, only one half of the respondents opined that they were aware of the standard medical abbreviations, about 65% claimed that they used standard abbreviations only. About 60% of the respondents admitted that they were comfortable with case history with abbreviations and only 10.4% had a discomfort in using abbreviations whilst recording case history. More than half the number of respondents felt a difficulty in understanding abbreviations written by others.

However a vast majority of the respondents (74%) were of the opinion that abbreviations should be permitted in case history taking.

The jargons used by the respondents are given in Table 3

DISCUSSION

Clearly, the world has become “smaller” due to the use of information and communications technologies.Effective communication requires the parties involved sharing a clear understanding of the various definitions and parameters about which information (and data) are being exchanged – in other words, are we talking about the same thing?

Here, language and, in particular, jargon, plays a key role. Even assuming that all parties have a reasonable command of a common language – for example, International English – the same words may have significantly different meanings to people from different parts of the world.Jargon is an abbreviated form of language that encapsulates tacit knowledge.(2)

As medical students, house surgeons, and residents, we pick it up from our peers and from attending physicians who should know better. We hear it at lectures and conferences. We read it in journals and textbooks. Eventually, we become inured to it, and we no longer recognize how ugly it is and how often it impairs effective communication.(5)

Medical jargon is often justified on the grounds that it constitutes a kind of medical shorthand, allowing more efficient communication when time is short. These examplesillustrate that jargon is often less informative.(5)

Although studies assessing the impact of jargons used by health care providers on the patients have been reported in the literature, not even a single study was found in the available electronic literature that assessed the impact of use of jargons among the health care personnel. As stated above, with the world becoming much smaller and with great developments in the field of communication, there needs to be uniformity in recording and reporting of medical data. Although, there exists a definite set of standard medical jargons, there is a serious lack of awareness regarding the same and there is a prolific use of abbreviations in case history taking, mistaking them for standard medical jargons. This often can result in a lack of effective communications among the colleagues and patients. With case history deserving a great importance as a medical record presently, uniformity needs to exist in documentation of medical records. Hence this study was conducted to assess the use of medical jargons among dentists and their impact on the peers.

A very significant observation in this study was all the 549 respondents of the study used jargons in their case history taking. Moreover, only 56% of the respondents admitted to using jargons only when there was a lack of time. This habit is significantly greater in students compared to house surgeons and faculty. This highlights the fact that use of jargons/shorthand has become an integral component of writing for a significant proportion of the population. The growing and overzealous use of short messaging service and social media may have a significant role to play in this regard. This has in fact become a current topic of concern. Various researches conducted in this regard (6-8) indicate the influence of texting on English language. Although the results are debatable, there is a clear preference for the present generation to use abbreviations over full forms everywhere. Thus the observation that about half the number of respondents use jargons as they find it easy. Over 70% admit learning these jargons from their colleagues which is again matter of concern. Yet another important observation is that about 65% of the respondents believe that they use standard medical jargons only. However, in reality, as per this study, vast majority of the jargons used are not standard jargons. Moreover, an institution-wise comparison of the jargons used by the respondents, reveals that there a definite variation among the institutions in the same geographical area. Even more important is the fact that there were abbreviations, the use of which was restricted to a single institution, which the respondents in the neighbouring institutions were unaware of, clearly ascertaining the fact that these abbreviations are created according to one’s convenience. This accounts for the lack of uniformity in the jargons used, as reported. Ironically, only c/o, h/o and w.r.t among the abbreviations reportedly being used by the respondents can be described as standard medical jargons (9).

It is a noteworthy point that, over 60% of the respondents use jargons in recording patient’s personal information and history section. Guidelines in case history taking indicate that that these sections demand the use of a language which the patient can comprehend. (10) With case history record serving as important legal evidence in medico-legal cases, uniformity needs to be strictly maintained in its recording.

Furthermore, in spite of about 55% reporting a difficulty in understanding the abbreviations used by their colleagues/students, a response which is significantly greater among faculty members. About 60% feel they are comfortable regarding case history with abbreviations. This is significantly higher among undergraduate students. However, majority of the post graduate students and faculty members opined that they were comfortable with case history without abbreviations. Although about 50% of the respondents claim that they are aware of the standard medical abbreviations, it was found to be false. This indicates that there is lack of adequate knowledge regarding the same. Most importantly, with about 85% opining that there is no need to stop the use of abbreviations, there is a clear reflection of the attitude of the respondents towards the same. A statistically significant difference in this regard between students and faculty members reveal that faculty members opined regarding the stop of use of abbreviations.

This study thus throws a light on an issue which demands a serious action. Furthermore this study warns us that this practice is leading to damage to the use and purpose of medical recordkeeping, which can have a serious impact in the long run.

Recommendations

With lack of awareness being one of the most common reason for this observation, efforts to improve the awareness by incorporating the same in the curriculum can be recommended. The faculty members have a major role of play in this regard by ensuring that the students record the case history without abbreviations/jargons.

CONCLUSION

This study points out that there is a widespread use of jargons/abbreviations in case history taking among the clinical dental undergraduate students, house surgeons, post graduate students and faculty members in dental colleges in Ernakulam and Idukki districts. There is a lack of knowledge regarding standard medical abbreviations. Although majority of the respondents are comfortable with the use of jargons, majority of the postgraduates and faculty feel the use of jargons should be stopped.

REFERENCES

1. Fenske RE. The Use of Jargon in Medical School Libraries. Bull. Med. Libr. Assoc. 1986;74(1):12-15.
2. Baldi S, Gelbstein E. Jargon, protocols and uniforms as barriers to effective communication. Intercultural Communication and Diplomacy 225-40, assessed online on 25-01-2015.
3. McQuoid-Mason D, Pillemer B, Friedman C, Dada M. Medical records, reports and evidence in court. Crimes against women and children – a medicolegal guide. 2002. Published by Independent medicolegan unit, University of Natal, accessed online on 28-01-15.
4. Graham S, Brookey J. Do patients understand? The Permanente Journal 2008;12(3):67-9.
5. Ronal PM. A bad case of medical jargon. Pitfalls in medical writing. American Journal of Roentegenology 1993;161:592.
6. Aziz S, Shamim M, Aziz MF, Avais P.The Impact of Texting/SMS Language on Academic Writing of Students- What do we need to panic about? Elixir Ling. & Trans. 2013;55:12884-12890
7. Mahmoud SS. The Effect of Using English SMS on KAU Foundation Year Students’ Speaking and Writing Performance. American International Journal of Social Science 2013;2(2):13-22.
8. Ochonogor WC, Alakpodia NO, Achugbue IE.The Impact of Text Message Slang (Tms) or Chartroom Slang on Students Academic Performance. International Journal of Internet of Things 2012;1(2):1-4.
9. Common medical jargons. Assessed online stedmansonline.com/webFiles/Dict-Stedmans28/APP06.pdf on 23/01/15.
10. Ghom AG. Textbook of Oral Medicine. 2014, third edition, Jaypee brothers Publishing.