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Sample records for ground medical consultation

  1. Asynchronous Remote Medical Consultation for Ghana

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    Luk, Rowena; Aoki, Paul M

    2008-01-01

    Computer-mediated communication systems can be used to bridge the gap between doctors in underserved regions with local shortages of medical expertise and medical specialists worldwide. To this end, we describe the design of a prototype remote consultation system intended to provide the social, institutional and infrastructural context for sustained, self-organizing growth of a globally-distributed Ghanaian medical community. The design is grounded in an iterative design process that included two rounds of extended design fieldwork throughout Ghana and draws on three key design principles (social networks as a framework on which to build incentives within a self-organizing network; optional and incremental integration with existing referral mechanisms; and a weakly-connected, distributed architecture that allows for a highly interactive, responsive system despite failures in connectivity). We discuss initial experiences from an ongoing trial deployment in southern Ghana.

  2. Tips for telephone and electronic medical consultation.

    Science.gov (United States)

    Gupta, Sailesh G

    2013-11-01

    The world is gradually shrinking in terms of time, and communications, while expanding in terms of population and distances. Patients demand and expect telephone and e-mail consultations and medical professionals are only too happy to oblige. However, a telephone consult is never so satisfying for the patients and well as the doctor as a face consult. Besides much essential information, cues and clues to diagnosis may be missed only with an audio input from patients. A telephone consult should be offered only to know the patient, and only after a prior face consult. It should be ensured that the patient can definitely understand, and follow the directions, and manage the disorder at home. While a telephone consultation may be considered convenient and short, there may be several disadvantages of such consultation, a wrong diagnosis and an inappropriate prescription being just two of them. Telephone etiquette should be followed by the staff and the physician. A triage system may be set up to filter calls that need to be necessarily answered by the physician himself. Telephone consults should be charged, and should be followed by a face consult as soon as possible. E-mail consultations are governed essentially by the same principles that govern telephone consultations. There is a slight advantage of e-mail consultation in that reports can be submitted online, including radiological reports. However, confidentiality is an important and uncertain issue in cyber space. A memorandum of understanding maybe signed between the patient and the physician. The information provided on e-mail should be of a general nature and a face consult should precede e-mail consultation. Patients may be referred to web resources for information. Telemedicine is a useful tool to obtain a medical diagnosis and to provide medical advice, and is likely to be used vastly in the near future.

  3. [Remote medical consultations in gerontology].

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    Mathieu-Fritz, Alexandre; Esterle, Laurence; Espinoza, Pierre

    2012-01-01

    Experimental teleconsultations have been set up between a university hospital and a public geriatric hospital in Paris in order to facilitate elderly patients' access to specialist consultations. Caregivers have had to accept major changes to their professional practices (delegation of tasks, sharing of knowledge, etc.). This new telemedecine scheme represents huge progress in patient care.

  4. A Grounded Theory Study of Supervision of Preservice Consultation Training

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    Newman, Daniel S.

    2012-01-01

    The purpose of this study was to explore a university-based supervision process for consultants-in-training (CITs) engaged in a preservice level consultation course with applied practicum experience. The study was approached from a constructivist worldview using a grounded theory methodology. Data consisted of supervision session transcripts,…

  5. Consultation of medical narratives in the electronic medical record.

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    Tange, H J

    1999-12-01

    This article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much

  6. How lead consultants approach educational change in postgraduate medical education.

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    Fokkema, J.P.; Westerman, M.; Teunissen, P.W.; Lee, N.; Scherpbier, A.J.J.A.; Vleuten, C.P.M. van der; Dorr, P.J.; Scheele, F.

    2012-01-01

    CONTEXT: Consultants in charge of postgraduate medical education (PGME) in hospital departments ('lead consultants') are responsible for the implementation of educational change. Although difficulties in innovating in medical education are described in the literature, little is known about how lead

  7. Consultation Barriers between Teachers and External Consultants: A Grounded Theory of Change Resistance in School Consultation

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    Thornberg, Robert

    2014-01-01

    The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…

  8. Consultation Barriers between Teachers and External Consultants: A Grounded Theory of Change Resistance in School Consultation

    Science.gov (United States)

    Thornberg, Robert

    2014-01-01

    The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…

  9. Consultation letters for medically unexplained physical symptoms in primary care

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    Hoedeman, Rob; Blankenstein, Annette H.; van der Feltz-Cornelis, Christina M.; Krol, Boudien; Stewart, Roy; Groothoff, Johan W.; van der Feltz-Cornelis, CM

    2010-01-01

    Background In primary care between 10% and 35% of all visits concern patients with medically unexplained physical symptoms (MUPS). MUPS are associated with high medical consumption, significant disabilities and psychiatricmorbidity. Objectives To assess the effectiveness of consultation letters (CLs

  10. [Tips for hosting a medical student in a PC consultation].

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    Félix, Sylvie; Bonvin, Raphaël; Bischoff, Thomas

    2010-05-19

    Hosting a medical student in one's primary care consultation challenges the practitioner to be a clinical teacher as well as providing high-quality patient care. A few tips can make this double task easier. Before the consultation it is possible to define the student's learning objectives and to plan the consultation. During the consultation itself some teaching models exist (One minute preceptor, SNAPP) that facilitate the teaching by maximising the teaching moments for each student-patient encounter. And finally after the consultation a time of reflection where both student and clinical teacher can think about what went well and what could be done better.

  11. 42 CFR 431.105 - Consultation to medical facilities.

    Science.gov (United States)

    2010-10-01

    ... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION... State agencies furnish consultative services to hospitals, nursing homes, home health agencies, clinics... and child health and crippled children's program (title V of the Act), Medicaid or Medicare;...

  12. Teaching Medical Gerontology: Utilization of a Psychiatry Consultation Program.

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    Hall, Georgia G.; Starkman, Monica N.

    1979-01-01

    A pilot project to explore the feasibility of using the clinical Adult Service Psychiatry Consultation-Liaison Program at the University of Michigan as the locus for teaching medical gerontology to psychiatric and medical/surgical residents and medical students is described. The goals, techniques, content, and implementation procedures are…

  13. Teaching medical students consultation skills using e-learning

    DEFF Research Database (Denmark)

    Jørgensen, Merete; Witt, Klaus; Fridorff-Jens, Peter Kindt

    2015-01-01

    Teaching consultation skills to medical students using e-learning. Introduction: We have been teaching Family Medicine at the University of Copenhagen for more than twenty years. We wish to develop a method to evaluate the current teaching of consultation skills and the effect of new interventions...... general practice consultations. 1. Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB. The patient-centred clinical method. A model for the doctor-patient interaction in family medicine. Fam Pract. 1986 Mar; 3(1):24-30. 2. Warnecke E, Pearson S. Medical students' perceptions of using e-learning...

  14. Development of a telepresence robot for medical consultation

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    Bugtai, Nilo T.; Ong, Aira Patrice R.; Angeles, Patrick Bryan C.; Cervera, John Keen P.; Ganzon, Rachel Ann E.; Villanueva, Carlos A. G.; Maniquis, Samuel Nazirite F.

    2017-02-01

    There are numerous efforts to add value for telehealth applications in the country. In this study, the design of a telepresence doctor to facilitate remote medical consultations in the wards of Philippine General Hospital is proposed. This includes the design of a robot capable of performing a medical consultation with clear audio and video information for both ends. It also provides the operating doctor full control of the telepresence robot and gives a user-friendly interface for the controlling doctor. The results have shown that it provides a stable and reliable mobile medical service through the use of the telepresence robot.

  15. [Analysis of ambulatory consultation length in medical clinics].

    Science.gov (United States)

    Outomuro, Delia; Actis, Andrea Mariel

    2013-03-01

    Planning a schedule for medical appointments in health services must be efficient and flexible, but also it has to meet the needs of patients, health professionals and non-medical staff. There are large differences in the opinión about the optimal duration to meet these objectives, across countries. In this paper we propose to perform a review of the literature to estímate the appropriate length ofa medical consultation in primary care, based on international standards. We conclude that managers of health systems should rethink the way they organize the agenda for medical appointments. Medical and bioethical reasons suggest assigning a lapse cióse to 20 minutes for consultations in medical clinics.

  16. A comparison of general medical and clinical ethics consultations: what can we learn from each other?

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    Geppert, Cynthia M A; Shelton, Wayne N

    2012-04-01

    Despite the emergence of clinical ethics consultation as a clinical service in recent years, little is known about how clinical ethics consultation differs from, or is the same as, other medical consultations. A critical assessment of the similarities and differences between these 2 types of consultations is important to help the medical community appreciate ethics consultation as a vital service in today's health care setting. Therefore, this Special Article presents a comparison of medical and clinical ethics consultations in terms of fundamental goals of consultation, roles of consultants, and methodologic approaches to consultation, concluding with reflections on important lessons about the physician-patient relationship and medical education that may benefit practicing internists. Our aim is to examine ethics consultation as a clinical service integral to the medical care of patients. Studies for this analysis were obtained through the PubMed database using the keywords ethics consultation, medical consultation, ethics consults, medical consults, ethics consultants, and medical consultants. All English-language articles published from 1970 through August 2011 that pertained to the structure and process of medical and ethics consultation were reviewed.

  17. Using professional interpreters in undergraduate medical consultation skills teaching.

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    Bansal, Aarti; Swann, Jennifer; Smithson, William Henry

    2014-01-01

    The ability to work with interpreters is a core skill for UK medical graduates. At the University of Sheffield Medical School, this teaching was identified as a gap in the curriculum. Teaching was developed to use professional interpreters in role-play, based on evidence that professional interpreters improve health outcomes for patients with limited English proficiency. Other principles guiding the development of the teaching were an experiential learning format, integration to the core consultation skills curriculum, and sustainable delivery. The session was aligned with existing consultation skills teaching to retain the small-group experiential format and general practitioner (GP) tutor. Core curricular time was found through conversion of an existing consultation skills session. Language pairs of professional interpreters worked with each small group, with one playing patient and the other playing interpreter. These professional interpreters attended training in the scenarios so that they could learn to act as patient and family interpreter. GP tutors attended training sessions to help them facilitate the session. This enhanced the sustainability of the session by providing a cohort of tutors able to pass on their expertise to new staff through the existing shadowing process. Tutors felt that the involvement of professional interpreters improved student engagement. Student evaluation of the teaching suggests that the learning objectives were achieved. Faculty evaluation by GP tutors suggests that they perceived the teaching to be worthwhile and that the training they received had helped improve their own clinical practice in consulting through interpreters. We offer the following recommendations to others who may be interested in developing teaching on interpreted consultations within their core curriculum: 1) consider recruiting professional interpreters as a teaching resource; 2) align the teaching to existing consultation skills sessions to aid integration

  18. Real Time Medical Image Consultation System Through Internet

    Directory of Open Access Journals (Sweden)

    D. Durga Prasad

    2010-01-01

    Full Text Available Teleconsultation among doctors using a telemedicine system typically involves dealing with and sharing medical images of the patients. This paper describes a software tool written in Java which enables the participating doctors to view medical images such as blood slides, X-Ray, USG, ECG etc. online and even allows them to mark and/or zoom specific areas. It is a multi-party secure image communication system tool that can be used by doctors and medical consultants over the Internet.

  19. Using professional interpreters in undergraduate medical consultation skills teaching

    Directory of Open Access Journals (Sweden)

    Bansal A

    2014-11-01

    Full Text Available Aarti Bansal,1 Jennifer Swann,1 William Henry Smithson2 1Academic Unit of Primary Medical Care, University of Sheffield, UK; 2Department of General Practice, University College Cork, Cork, Ireland Abstract: The ability to work with interpreters is a core skill for UK medical graduates. At the University of Sheffield Medical School, this teaching was identified as a gap in the curriculum. Teaching was developed to use professional interpreters in role-play, based on evidence that professional interpreters improve health outcomes for patients with limited English proficiency. Other principles guiding the development of the teaching were an experiential learning format, integration to the core consultation skills curriculum, and sustainable delivery. The session was aligned with existing consultation skills teaching to retain the small-group experiential format and general practitioner (GP tutor. Core curricular time was found through conversion of an existing consultation skills session. Language pairs of professional interpreters worked with each small group, with one playing patient and the other playing interpreter. These professional interpreters attended training in the scenarios so that they could learn to act as patient and family interpreter. GP tutors attended training sessions to help them facilitate the session. This enhanced the sustainability of the session by providing a cohort of tutors able to pass on their expertise to new staff through the existing shadowing process. Tutors felt that the involvement of professional interpreters improved student engagement. Student evaluation of the teaching suggests that the learning objectives were achieved. Faculty evaluation by GP tutors suggests that they perceived the teaching to be worthwhile and that the training they received had helped improve their own clinical practice in consulting through interpreters. We offer the following recommendations to others who may be interested in

  20. Participation of chronic patients in medical consultations: patients’ perceived efficacy, barriers and interest in support.

    NARCIS (Netherlands)

    Henselmans, I.; Heijmans, M.; Rademakers, J.; Dulmen, S. van

    2015-01-01

    Aims: Chronic patients are increasingly expected to participate actively in medical consultations. This study examined (i) patients' perceived efficacy and barriers to participation in consultations, (ii) patients' interest in communication support and (iii) correlates of perceived efficacy and

  1. Doctor-patient dialogue--basic aspect of medical consultation.

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    Murariu-Brujbu, Isabella Cristina; Macovei, Luana Andreea

    2013-01-01

    Family medicine is the specialty that provides ongoing primary medical care and improves the health status of the individual, of the family and of the community through preventive, educational, therapeutic and rehabilitation measures. The family doctor often makes the interdisciplinary synthesis, in a flexible manner, either alone or in most cases with interdisciplinary consultation. In the latter case, the family doctor initiates the team work and makes the final evaluation by using the longitudinal follow-up of the disease. The doctor-patient encounter represents the "confrontation" with the greatest moral weight, due to the complexity of the values involved, the status of the doctor in a society, and patient's involvement in decision making. The patient is a person who should be treated with respect, honesty, professionalism and loyalty, whatever the clinical status, severity of illness, mental competence or incompetence. A focus, on an international scale, is represented by the characteristics of a good doctor, family physician included, as the latter is the first link in the network of health services. Each model of consultation varies in a more or less subtle way in priorities assignment, and suggests slight differences regarding the role played by doctor and patient in their collaboration. The qualities of a good family physician include not only the strictly professional competences, that also apply to other medical specialties, but also duties, such as, clearly explaining to patients issues concerning their health, informing them about all the possible preventive measures of diseases, making a diagnosis, initiating and supervising a therapy. Medical responsibility lies at the crossroads between medical science and the conscience of the doctor.

  2. Mechanisms for exchange of image data to support distant medical consultation.

    OpenAIRE

    Dayhoff, R. E.; Maloney, D. L.; Hirz, L.; Majurski, W. J.; Kuzmak, P. M.; Bradley, D.

    1993-01-01

    The VA has developed an integrated infrastructure to support the exchange of medical data, including images and text report data, between medical centers. This capability is expected to support teleconsulting and meet a variety of existing medical staffing and consultation needs. Consultation from distant locations requires at least the same complete integrated patient record available to onsite physicians. Several mechanisms are being explored to support distant medical consultation. Multime...

  3. [The role of the medical geneticist in the pediatric consultation].

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    Araujo-Solís, María Antonieta de Jesús; Huicochea-Montiel, Juan Carlos; Vázquez-Estupiñán, Felipe

    2014-01-01

    The work of the medical geneticist is, from the clinical point of view, scarcely known. His healthcare-related activity requires close collaboration with specialists in different fields; hence, it is vital for the physician directly in charge of the patient to have at hand some useful recommendations in order to make care provided by the multidisciplinary team efficient and timely. The purpose of this paper is to outline some of the professional features of medical genetics specialists and to describe, in general terms, the work in clinical genetics, as well as to inform first contact clinicians - especially pediatricians - about the clinical and imaging studies they should order for patients with the most common congenital conditions before referring them for diagnostic or genetic counseling. It is important to point out that the communication process between the treating clinician and his/her patients (which in pediatric patients is with the family) is essential not only with regard to the reason for referral to the medical genetics department, but also for the family to be able to obtain information prior to the appointment, so that time and quality of care are improved once the genetics consultation takes place. Finally, this manuscript outlines the requirements for the communication between specialists, in order for them to promote and provide knowledge on medical genetics at all levels of care, for the benefit of patients.

  4. "Well, Now, Okey Dokey": English Discourse Markers in Spanish-Language Medical Consultations

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    Vickers, Caroline; Goble, Ryan

    2011-01-01

    The purpose of this article is to examine the use of English discourse markers (EDMs) in medical consultations that were conducted in Spanish. Data are collected from an audio-recorded corpus of Spanish-language consultations that took place in a small community clinic in the United States as well as post-consultation interviews with patients and…

  5. Evolving techniques in text-based medical consultation - Physicians' long-term experiences at an Ask the doctor service.

    Science.gov (United States)

    Björk, Anna Bell; Hillborg, Helene; Augutis, Marika; Umefjord, Göran

    2017-09-01

    Both the demands and the options for patients to communicate with health care providers utilizing eHealth solutions are increasing. Some patients, or relatives to patients, want to consult another health care provider than the regular one, merely in text. To improve text-based medical consultation by learning from long-term experiences. Physicians with comprehensive experience of answering free-text medical inquiries at an official health portal in Sweden were interviewed. The interviews were analyzed using a grounded theory approach. Over time, the interviewed physicians developed strategies on how to formulate the answer to a medical inquiry from a previously unknown inquirer. The answering physicians experienced their primary role as providers of medical information and as mediators between an inquirer and the regular health care provider. Many of the answering physicians experienced a personal development with improved communication skills, also in face-to-face meetings with patients. Text-based medical consultation is part of an expanding area in eHealth. The development of strategies, guidelines, ethical considerations as well as educational efforts are needed to optimize the skills of asynchronous text-based health consultation. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. E-consulting in a medical specialist setting: Medicine of the future?

    Science.gov (United States)

    Zandbelt, Linda C; de Kanter, Froukje E C; Ubbink, Dirk T

    2016-05-01

    Today's technology provides new ways of consulting between patients and medical specialists in health care, such as videoconferencing and web-messaging. In this systematic review we assessed the effects of e-consulting between medical specialists and patients. We searched MEDLINE, EMBASE, Psychlit and Cochrane Library for randomized clinical trials assessing the use of e-consulting methods (videoconferencing (VC) or web-messaging (WM)), as compared to conventional care (face-to-face (FF) or telephone consultations (TC)) in a medical specialist setting. We extracted patient-related, physician-related, cost, time and follow-up outcomes. We included 21 trials, of which 17 addressed VC compared to FF, two compared WM with FF, one VC with TC, and one WM with TC. Physicians appeared to prefer face-to-face consultations over videoconferencing. Patients appeared to be as satisfied with videoconferencing as with face-to-face contacts, but preferred videoconferencing and web-messaging over telephone consultations. Videoconferencing was more expensive regarding equipment, but saved patient-related costs in terms of time, transportation, and missed work. Variable results were found for consult time and follow-up visits. We cautiously conclude that e-consulting seems a feasible alternative to medical specialists' face-to-face follow-up or telephone appointments, but may be less suitable for initial consultations requiring physical examination. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Reasons for medical consultation among members of the Indian Scientific Expeditions to Antarctica

    Directory of Open Access Journals (Sweden)

    Abhijeet Bhatia

    2013-02-01

    Full Text Available The article attempts to analyze the disease burden in a healthy, pre-screened population subjected to prolonged residence in the hostile environment of Antarctica. This retrospective epidemiological study was conducted utilizing data from medical consultation room on board the Indian Antarctic expedition vessels and at Indian Antarctic station, Maitri from seven Indian Scientific Expeditions to Antarctica (ISEA. The study group (n=327 consisted of 325 men and two women. The total number of medical room consultations was 1989. Maximum consultations were for injuries (27.25%; 14.68% were musculoskeletal and 10.31% were bruises and lacerations. Disturbances of gastrointestinal tract (19.66% were the second most common disorders. Psychological disturbances accounted for 2.66% consultations. Cold injuries constituted 2.01% consultations and photophthalmia accounted for 1.06% consultations.

  8. iMedic: a two-handed immersive medical environment for distributed interactive consultation.

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    Mlyniec, Paul; Jerald, Jason; Yoganandan, Arun; Seagull, F Jacob; Toledo, Fernando; Schultheis, Udo

    2011-01-01

    We describe a two-handed immersive and distributed 3D medical system that enables intuitive interaction with multimedia objects and space. The system is applicable to a number of virtual reality and tele-consulting scenarios. Various features were implemented, including measurement tools, interactive segmentation, non-orthogonal planar views, and 3D markup. User studies demonstrated the system's effectiveness in fundamental 3D tasks, showing that iMedic's two-handed interface enables placement and construction of 3D objects 4.5-4.7 times as fast as a mouse interface and 1.3-1.7 times as fast as a one-handed wand interface. In addition, avatar-to-avatar collaboration (two iMedic users in a shared space-one subject and one mentor) was shown to be more effective than face-to-face collaboration (one iMedic user/subject and one live mentor) for three tasks.

  9. [Parents' and medical employees' accuracy in the estimation of fees for consultations and frequent medical procedures].

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    Sztulman, L; Szternberg, A; Grouteau, E; Claudet, I

    2011-11-01

    To analyze the accuracy of estimates made by medical staff and parents regarding fees for consultations and frequently prescribed medical exams. The questionnaire focused on the value in euros for the following: day and night consultation in the pediatric emergency department, blood and urine analysis, electrocardiogram, chest and abdominal x-ray, abdominal ultrasound, upper digestive endoscopy, CT scan, cerebral MRI (without anesthesia), an arm cast, and superficial wound repair. Medical staff belonged to different units of the childrens' hospital. The parents interviewed had consulted at the pediatric emergency unit. Neither of the two investigators was familiar with the fee structure. To avoid inducing a gradation in estimates, questions were asked with no pre-established order. To limit the possibility of participants discussing the questionnaire with their colleagues or searching for the real value, all medical staff members were assessed within a 48-h period. The responses of 185 medical employees (23 pediatricians, 28 interns, 81 nurses, 45 childcare assistants, seven nurse supervisors) and 187 parents were analyzed and compared. Less than 25% of the population gave an answer with an accepted error of ± 30%. Parents and hospital staff overestimated costs, parents and childcare assistants overestimated more than other medical employees. Radiological exams were the most overestimated procedures with the largest proportion of the average deviation from normal value: CT scan 850 ± 1100%, cerebral MRI 370 ± 590%, abdominal x-ray 240 ± 390%, and chest x-ray 190 ± 320%. Part of our societal culture and now a requirement, the right to healthcare has a cost. This cost is often overestimated by caregivers and the general population. Global understanding of the costs related to medical care requires educating the population and medical professionals. Medical staff should be informed of the real costs of treatment to enable them to manage unnecessary costs. There

  10. [Medication adverse events: Impact of pharmaceutical consultations during the hospitalization of patients].

    Science.gov (United States)

    Santucci, R; Levêque, D; Herbrecht, R; Fischbach, M; Gérout, A C; Untereiner, C; Bouayad-Agha, K; Couturier, F

    2014-11-01

    The medication iatrogenic events are responsible for nearly one iatrogenic event in five. The main purpose of this prospective multicenter study is to determine the effect of pharmaceutical consultations on the occurrence of medication adverse events during hospitalization (MAE). The other objectives are to study the impact of age, of the number of medications and pharmaceutical consultations on the risk of MAE. The pharmaceutical consultation is associated to a complete reassessment done by both a physician and a pharmacist for the home medication, the hospital treatment (3days after admission), the treatment during chemotherapy, and/or, the treatment when the patient goes back home. All MAE are subject to an advice for the patient, additional clinical-biological monitoring and/or prescription changes. Among the 318 patients, 217 (68%) had 1 or more clinically important MAE (89% drug-drug interaction, 8% dosing error, 2% indication error, 1% risk behavior). The patients have had 1121 pharmaceutical consultations (3.2±1.4/patient). Thus, the pharmaceutical consultations divided by 2.34 the risk of MAE (unadjusted incidence ratio, P≤0.05). Each consultation decreased by 24% the risk of MAE. Moreover, adding one medication increases from 14 to 30% as a risk of MAE on the population. Pharmaceutical consultations during the hospital stay could reduce significantly the number of medication adverse effects. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  11. The Concept of Body Language in the Medical Consultation.

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    Lindsley, Isabella; Woodhead, Sophie; Micallef, Claranne; Agius, Mark

    2015-09-01

    In this paper we wish to argue that the human body is an instrument of communication that can be used by the individual. This can be shown by the use of phenomenology, as described by Husserl, and that indeed empathy, as described by phenomenology, can be seen as a link enabling two human bodies/persons to communicate. We then wish to show from neuroscience that empathy can itself be seen as a bodily function. We then will describe how the doctor-patient relationship in the consultation is an extremely important type of communication between two persons, and how teaching of consultation skills has developed. We will show that, once consultation skills teaching was established, then study of body language became an essential part of this teaching, as soon as the technology was developed, and finally we will demonstrate that it is now possible to confirm by observational and controlled trials that appropriate use of body language does indeed enhance the effectiveness of the consultation, including, we would suggest, by appropriate communication of empathy and understanding.

  12. Predictive Factors for Medical Consultation for Sore Throat in Adults with Recurrent Pharyngotonsillitis

    Directory of Open Access Journals (Sweden)

    T. Koskenkorva

    2016-01-01

    Full Text Available Objects. To seek patient- and episode-related factors that associate with medical consultation for acute sore throat because these factors may affect the patient being referred to specialist care and tonsillectomy for recurrent pharyngotonsillitis. Methods. In a secondary analysis of two prior randomised controlled trials, sore throat episodes and medical visits were explored among 156 adult patients referred for tonsillectomy because of recurrent pharyngotonsillitis. Results. The 156 patients (104 females, mean age of 26 years suffered from 208 acute pharyngotonsillitis episodes during 5-6 months of follow-up. Forty (25% patients visited a physician, and female gender (adjusted hazard ratio, HR, 3.3; 95% confidence interval 1.4–8.0 and finding of chronically infected tonsils (HR 2.7; 1.2–6.1 were associated with medical consultation. Thirty-six (17% episodes led to medical consultation during the first 7 days of symptoms. Presence of severe throat pain was related to medical visit (HR 4.3; 1.0–18.5. Conclusions. Even among patients with recurrent pharyngotonsillitis, the acute sore throat episodes were usually mild and only few resulted in medical consultation, with female gender, chronically infected tonsils, and having severe throat pain increasing the consultation rate.

  13. Mechanisms for exchange of image data to support distant medical consultation.

    Science.gov (United States)

    Dayhoff, R E; Maloney, D L; Hirz, L; Majurski, W J; Kuzmak, P M; Bradley, D

    1993-01-01

    The VA has developed an integrated infrastructure to support the exchange of medical data, including images and text report data, between medical centers. This capability is expected to support teleconsulting and meet a variety of existing medical staffing and consultation needs. Consultation from distant locations requires at least the same complete integrated patient record available to onsite physicians. Several mechanisms are being explored to support distant medical consultation. Multimedia extensions to the VA's electronic mail system have been developed to allow images and other data objects to be included in electronic mail messages. Another approach that has been prototyped is to extend existing local imaging networks to produce more widely distributed imaging systems. These approaches will be described and discussed.

  14. Argumentation in doctor-patient interaction: medical consultation as a pragma-dialectical communicative activity type

    NARCIS (Netherlands)

    Pilgram, R.

    2009-01-01

    In medical consultation, the doctor’s advice (or the support for it) is not always immediately acceptable to the patient. The medical advice might, for instance,mean that the patient has to drastically change his behaviour. An important way in which the doctor can nonetheless make his advice accepta

  15. The 5Cs of Consultation: Training Medical Students to Communicate Effectively in the Emergency Department.

    Science.gov (United States)

    Kessler, Chad S; Tadisina, Kashyap Komarraju; Saks, Mark; Franzen, Doug; Woods, Rob; Banh, Kenny V; Bounds, Richard; Smith, Michael; Deiorio, Nicole; Schwartz, Alan

    2015-11-01

    Effective communication is critical for health care professionals, particularly in the Emergency Department (ED). However, currently, there is no standardized consultation model that is consistently practiced by physicians or used for training medical graduates. Recently, the 5Cs of Consultation model (Contact, Communicate, Core Question, Collaborate, and Close the Loop) has been studied in Emergency Medicine residents using simulated consultation scenarios. Using an experimental design, we aimed to evaluate the efficacy of the 5Cs consultation model in a novel learner population (medical students) and in a "real time and real world" clinical setting. A prospective, randomized, controlled study was conducted at eight large, academic, urban, tertiary-care medical centers (U.S. and Canada). Intervention involved two experimental groups (asynchronous and live training) compared to a baseline control group. All participants placed up to four consult phone calls. A senior physician observed and assessed each call using a preapproved 5Cs checklist and a Global Rating Scale (GRS). Participants who received training (asynchronous or live) scored significantly higher on the 5Cs checklist total and GRS than the control group. Both training methods (asynchronous and live) were equally effective. Importantly, learning gains were sustained as students' 5Cs checklist total and GRS scores remained consistently higher at their second, third, and fourth consult (relative to their first consult). At posttest, all participants reported feeling more confident and competent in relaying patient information. Medical students can be trained to use the 5Cs model in a timely, inexpensive, and convenient manner and increase effectiveness of physician consultations originating from the ED. Published by Elsevier Inc.

  16. Medical students' medication communication skills regarding drug prescription-a qualitative analysis of simulated physician-patient consultations.

    Science.gov (United States)

    Hauser, Katarina; Matthes, Jan

    2017-04-01

    Poor medication communication of physicians to patients is detrimental, e.g. for medication adherence. Reasons for physicians' deficits in medication communication may be unfavourable conditions in daily practice or already insufficient training during their (undergraduate) medical studies. We explored medical students' communication on new medications in simulated physician-patient conversations to identify actual deficits indicating apparent educational needs. Fifth year medical students attending a mandatory course at the University of Cologne had simulated physician-patient consultations aiming at drug prescription. In 2015, 21 consultations were recorded, transcribed and subjected to qualitative content analysis based on the method of inductive coding. Even essential information on drug therapy was often lacking (e.g. adverse effects, drug administration). Some aspects were addressed more frequently than others. This seemed to differ depending on the diagnosis underlying the particular treatment (acute event vs. chronic disease). The extent of information on drug treatments given in simulated physician-patient consultations varied significantly between students. Fifth year medical students showed appreciable deficits in communicating drug prescriptions to patients though there were remarkable inter-individual differences. Our findings suggest that communication on drug therapy to patients is no self-evolving skill. Thus, there is obviously a need for emphasizing medication communication in the training of medical students. Communication aids specifically aiming at medication communication might facilitate learning of adequate medication communication skills.

  17. Narrative review of telemedicine consultation in medical practice

    Science.gov (United States)

    Di Cerbo, Alessandro; Morales-Medina, Julio Cesar; Palmieri, Beniamino; Iannitti, Tommaso

    2015-01-01

    Background The use of telemedicine has grown across several medical fields, due to the increasing number of “e-patients”. Objective This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care. Methods A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty). Results Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions. Conclusion Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time. PMID:25609928

  18. Narrative review of telemedicine consultation in medical practice

    Directory of Open Access Journals (Sweden)

    Di Cerbo A

    2015-01-01

    Full Text Available Alessandro Di Cerbo,1,2 Julio Cesar Morales-Medina,3 Beniamino Palmieri,1,2 Tommaso Iannitti4 1Poliambulatorio del Secondo Parere, 2Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy; 3Centro de Investigación en Reproducción Animal, CINVESTAV, Universidad Autónoma de Tlaxcala, Tlaxcala de Xicohténcatl, Mexico; 4Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN, University of Sheffield, Sheffield, UK Background: The use of telemedicine has grown across several medical fields, due to the increasing number of “e-patients”.Objective: This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care.Methods: A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-­medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty.Results: Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions.Conclusion: Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time. Keywords: telemedicine, health care, patient

  19. General practitioners' experiences as nursing home medical consultants

    OpenAIRE

    Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

    2017-01-01

    OBJECTIVE: To describe general practitioners' experiences of being the principal physician responsible for a nursing home. METHOD: Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. RESULT: Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-li...

  20. General practitioners' experiences as nursing home medical consultants.

    Science.gov (United States)

    Kirsebom, Marie; Hedström, Mariann; Pöder, Ulrika; Wadensten, Barbro

    2017-03-01

    To describe general practitioners' experiences of being the principal physician responsible for a nursing home. Fifteen general practitioners assigned to a nursing home participated in semi-structured qualitative interviews. Data were analysed using systematic text condensation. Medical assessment is the main duty of general practitioners. Advance care planning together with residents and family members facilitates future decisions on medical treatment and end-of-life care. Registered Nurses' continuity and competence are perceived as crucial to the quality of care, but inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The study highlights the importance of advance care planning together with residents and family members in facilitating future decisions on medical treatment and end-of-life care. To meet the increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care, there would seem to be a need to increase Registered Nurses' staffing and acquire more advanced medical equipment, as well as to create better possibilities for Registered Nurses and general practitioners to access each other's healthcare record systems. © 2016 Nordic College of Caring Science.

  1. Consultant medical trainers, modernising medical careers (MMC and the European time directive (EWTD: tensions and challenges in a changing medical education context

    Directory of Open Access Journals (Sweden)

    Payne Heather

    2008-05-01

    Full Text Available Abstract Background We analysed the learning and professional development narratives of Hospital Consultants training junior staff ('Consultant Trainers' in order to identify impediments to successful postgraduate medical training in the UK, in the context of Modernising Medical Careers (MMC and the European Working Time Directive (EWTD. Methods Qualitative study. Learning and continuing professional development (CPD, were discussed in the context of Consultant Trainers' personal biographies, organisational culture and medical education practices. We conducted life story interviews with 20 Hospital Consultants in six NHS Trusts in Wales in 2005. Results Consultant Trainers felt that new working patterns resulting from the EWTD and MMC have changed the nature of medical education. Loss of continuity of care, reduced clinical exposure of medical trainees and loss of the popular apprenticeship model were seen as detrimental for the quality of medical training and patient care. Consultant Trainers' perceptions of medical education were embedded in a traditional medical education culture, which expected long hours' availability, personal sacrifices and learning without formal educational support and supervision. Over-reliance on apprenticeship in combination with lack of organisational support for Consultant Trainers' new responsibilities, resulting from the introduction of MMC, and lack of interest in pursuing training in teaching, supervision and assessment represent potentially significant barriers to progress. Conclusion This study identifies issues with significant implications for the implementation of MMC within the context of EWTD. Postgraduate Deaneries, NHS Trusts and the new body; NHS: Medical Education England should deal with the deficiencies of MMC and challenges of ETWD and aspire to excellence. Further research is needed to investigate the views and educational practices of Consultant Medical Trainers and medical trainees.

  2. Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

    Science.gov (United States)

    Langley, G R; Till, J E

    1989-08-15

    To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relationship with patients, availability, family physician-consultant relationship and a fifth category that included organizational ability and personality attributes. The family physicians and the consultants placed different values on these categories and indicated that these values might change under different clinical circumstances. Their concepts appear to be compatible with, but not restricted to, a model of contemporary medical practice based on an ethic specific to medicine.

  3. Justification of diagnostic medical exposures: some practical issues. Report of an International Atomic Energy Agency Consultation.

    Science.gov (United States)

    Malone, J; Guleria, R; Craven, C; Horton, P; Järvinen, H; Mayo, J; O'reilly, G; Picano, E; Remedios, D; Le Heron, J; Rehani, M; Holmberg, O; Czarwinski, R

    2012-05-01

    The Radiation Protection of Patients Unit of the International Atomic Energy Agency (IAEA) is concerned about the effectiveness of justification of diagnostic medical exposures. Recent published work and the report of an initial IAEA consultation in the area gave grounds for such concerns. There is a significant level of inappropriate usage, and, in some cases, a poor level of awareness of dose and risk among some key groups involved. This article aims to address this. The IAEA convened a second group of experts in November 2008 to review practical and achievable actions that might lead to more effective justification. This report summarises the matters that this group considered and the outcome of their deliberations. There is a need for improved communication, both within professions and between professionals on one hand, and between professionals and the patients/public on the other. Coupled with this, the issue of consent to imaging procedures was revisited. The need for good evidence-based referral guidelines or criteria of acceptability was emphasised, as was the need for their global adaptation and dissemination. Clinical audit was regarded as a key tool in ensuring that justification becomes an effective, transparent and accountable part of normal radiological practice. In summary, justification would be facilitated by the "3 As": awareness, appropriateness and audit.

  4. Medical students’ perceptions of using e-learning to enhance the acquisition of consulting skills

    Directory of Open Access Journals (Sweden)

    Warnecke E

    2011-06-01

    Full Text Available BackgroundThis study aims to evaluate medical students’ perception ofthe usefulness and effectiveness of an e-learning packagedeveloped to enhance the acquisition of consulting skills.MethodA survey with mixed method data analysis was conducted.Participants were 67 medical students completing theirthird year primary care rotation as part of a five-year degreeat the University of Tasmania. Participants completed a 10question anonymous online survey after using the elearningpackageResultsOf the participants, 92% found it enjoyable and 95% foundthe e-learning package useful; 75% perceived it to beeffective in increasing their performance and 91% believedit increased their knowledge in consulting skills. Benefits forparticipants’ confidence, style and structure of consultingskills were found.ConclusionParticipants found the e-learning package to be enjoyableand effective. E-learning should be further utilised in ablended learning environment to support face-to-faceteaching in consulting skills.

  5. Psychotropic Medication Consultation in Schools: An Ethical and Legal Dilemma for School Psychologists

    Science.gov (United States)

    Carlson, John S.; Thaler, Cara L.; Hirsch, Amanda J.

    2006-01-01

    Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the…

  6. The impact of assessing simulated bad news consultations on medical students' stress response and communication performance.

    NARCIS (Netherlands)

    Dulmen, S. van; Tromp, F.; Grosfeld, F.; Cate, O. ten; Bensing, J.M.

    2007-01-01

    Seventy second-year medical students volunteered to participate in a study with the aim of evaluating the impact of the assessment of simulated bad news consultations on their physiological and psychological stress and communication performance. Measurements were taken of salivary cortisol, systolic

  7. [Strategy on the recruitment of free community medical-consultation in acupuncture clinical trials].

    Science.gov (United States)

    Fan, Hailong; Zhao, Ling; Li, Juan; Lv, Junling; Zhang, Linglin; Leng, Junyan; Zhang, Jie; Li, Dehua; Liang, Fanrong

    2016-04-01

    The difficulty in the participant recruitment is the common question in acupuncture clinical trial study. The existing recruitment of clinical trial is most applicable for the clinical trial of medicines. Because the intervention of acupuncture clinical trial is different from that of medicines, characterized as the specialties in "theory, principle, acupoints, technique", it is very necessary to develop the strategy on the participant recruitment in acupuncture clinical trial. The free community medical consultation is one of the important means of recruitment. In the paper, by taking the participant recruitment of acupuncture clinical trial on chronic stable angina pectoris as the example, the discussion is given on the strategy on the recruitment of free community medical consultation in the aspects of feasible investigation of recruitment approach, recruitment plan, participant screening, etc. The revisiting after the free community medical consultation is the important approach to the improvement of successful recruitment. This strategy on the recruitment of free community medical consultation is highly practical and improves the successful rate and compliance of the participant recruitment. Hence, this strategy deserves to be promoted.

  8. How patients would like to improve medical consultations: insights from a multicentre European study.

    NARCIS (Netherlands)

    Mazzi, M.A.; Rimondini, M.; Boerma, W.G.W.; Zimmermann, C.; Bensing, J.M.

    2016-01-01

    Objective: In a previous qualitative study (GULiVer-I), a series of lay-people derived recommendations (‘tips’) was listed for doctor and patient on ‘How to make medical consultation more effective from the patient’s perspective’. This work (GULiVer-II) aims to find evidence whether these tips can b

  9. A comparison of performances of consultant surgeons, NCHDs and medical students in a modified HPAT examination.

    LENUS (Irish Health Repository)

    Quinn, A

    2010-06-01

    Following the implementation of the Fottrell report, entry to medical school in Ireland has undergone significant change. Medical school studentship is now awarded based on a combination of points obtained from the final examination of Irish secondary schools (the leaving certificate) combined with HPAT scores (Health Professions Admissions Test). The HPAT is designed to test a candidate\\'s knowledge in several different fields including problem solving skills, logical and non verbal reasoning. A sample HPAT was administered to a test group composed of consultant surgeons, non consultant hospital doctors, and medical students. Statistical analysis was performed and no significant difference was found between the performances of the groups. This is surprising as it was expected that groups with greater experience at medical problem solving would have translated to higher scores. This exposes a flaw within the HPAT system and a potential weakness in the process of doctor selection.

  10. A Medical Consultation System to Support Health Care of Inhabitants through A Dialogue with Artificial Intelligence

    Science.gov (United States)

    Miyake, Hiroshi; Masuzawa, Hideaki

    A medical consultation system has been developed that encompasses knowledge of various specialties. The system is designed to be used by general practitioners, and inhabitants themselves. It has the characteristics of ; 1. The input task of complaints is simplified by use of multiple choice questionaires. 2. The system advices the person whether to seek medical help or not, and if so, the degree of urgency, and from what type of practitioner or specialist. 3. It supplies the doctor information regarding essential symptoms and possible diagnosis. 4. The system offer easy tools to make a medical consultation system to the specialists themselves. This system is intended as an answer to the common problem of uncertainty on the part of both inhabitants and doctors as to the area of medical speciality that applies to a given disease.

  11. High medical consultation rates of lead workers after industrial dispute over lead effects

    Energy Technology Data Exchange (ETDEWEB)

    Araki, S.; Murata, K.; Yanagihara, S.; Ushio, K.

    1982-02-01

    Medical consultation rates were compared between a group of lead workers and two groups of non-lead workers in a newspaper company where a serious industrial dispute took place over health effects of lead three years before this study. The comparison was also made within the group of lead workers. Maximal blood lead concentrations (PbBs) ranged from 0.1 ..mu..mol/kg to 3.6 ..mu..mol/kg with an average of 1.3 ..mu..mol/kg in the past three years. The consultation rate of lead workers was significantly higher than that of both the non-lead workers, when the number of workers who consulted physicians or dentists once or more for a year per 100 workers was compared. Disease-specific consultation rates were also higher in lead workers for seven categories of diseases and injuries such as hypertensive disease and peptic ulcers. When lead workers were divided into three groups by PbB or erythrocytes delta-aminolevulinic acid dehydratase (ALAD) levels, however, no significantly high rate was found in the higher PbB groups nor lower ALAD groups in terms of general and disease-specific consultation rates. It was concluded that the industrial dispute might have been a major cause of the high consultation rate of lead workers.

  12. Does the presence of medical students affect quality in general practice consultations?

    Science.gov (United States)

    Price, Richard; Spencer, John; Walker, Jeremy

    2008-04-01

    Previous studies have suggested that the patient's experience of a consultation with a doctor is not affected by the presence of medical students. However, no study has looked at the effect of student presence on conventional UK general practice consultations. This study aimed to measure the quality of the consultation as experienced by patients when students are present, to explore patients' attitudes to the presence of medical students, and to look at the relationships between these factors. We conducted a cross-sectional questionnaire study in general practices in north-east England. General practitioners (GPs) from practices teaching fourth and final year students administered questionnaires to patients who were seen in either teaching or non-teaching consultations. The questionnaire comprised previously validated measures of empathy and enablement as measures of quality, attitudinal statements regarding the presence of students, a scale rating pertaining to the patient's degree of acquaintance with the doctor, and items on demographic data. Results showed no significant differences in enablement scores between the 2 groups. Consultations with student presence last longer. Empathy scores were significantly lower in the 'student present' group, but the size of the difference was small. Attitudinal statements regarding the presence of students showed a high proportion of positive responses, and some groupings of negative ones. Further analysis demonstrated some significant links between attitudinal statements and enablement and empathy scores. The quality of general practice consultations was not adversely affected by medical student presence. However, significant numbers of patients who agreed to be seen with a student present were resistant to the student's presence.

  13. Elderly polypharmacy patients' needs and concerns regarding medication assessed using the structured patient-pharmacist consultation model

    NARCIS (Netherlands)

    Kovačević, Sandra Vezmar; Miljković, Branislava; Vučićević, Katarina; Ćulafić, Milica; Kovačević, Milena; Golubović, Bojana; Jovanović, Marija; de Gier, Johan J

    2017-01-01

    Objective: To evaluate elderly polypharmacy patients' needs and concerns regarding medication through the Structured Patient-Pharmacist Consultation (SPPC). Methods: Older patients on chronic treatment with > 5 medications were asked to fill in the SPPC form at home. A consultation with the communit

  14. [Bioethics in medical institutions--new custom or help? The example of clinical ethics consultation at a University Medical Center].

    Science.gov (United States)

    Richter, G

    2014-08-01

    Although ethics committees are well established in the medical sciences for human clinical trials, animal research and scientific integrity, the development of clinical ethics in German hospitals started much later during the first decade of the twenty-first century. Clinical ethics consultation should be pragmatic and problem-centered and can be defined as an ethically qualified and informed conflict management within a given legal framework to deal with and resolve value-driven, normative problems in the care of patients. Clinical ethics consultations enable shared clinical decision-making of all parties (e.g. clinicians, patients, family and surrogates) involved in a particular patient's care. The clinical ethicist does not act as an ethics expert by making independent recommendations or decisions; therefore, the focus is different from other medical consultants. Ethics consultation was first established by healthcare ethics committees (HEC) or clinical ethics consultation (CEC) groups which were called in to respond to an ethically problematic situation. To avoid ethical dilemmas or crises and to act preventively with regard to ethical issues in individual patients, an ethics liaison service is an additional option to ethics case consultations which take place on a regular basis by scheduled ethics rounds during the normal ward rounds. The presence of the ethicist offers some unique advantages: it allows early recognition of even minor ethical problems and accommodates the dynamics of ethical and clinical goal-setting in the course of patient care. Most importantly, regular and non-authoritative participation of the ethicist in normal ward rounds allows continuous ethical education of the staff within the everyday clinical routine. By facilitating clinical ethical decision-making, the ethicist seeks to empower physicians and medical staff to deal appropriately with ethical problems by themselves. Because of this proactive approach, the ethics liaison service

  15. The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach

    Directory of Open Access Journals (Sweden)

    Gu NY

    2008-12-01

    Full Text Available There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP pharmacy. The Smith-Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p<0.010. However, the bivariate probit models revealed that the marginal effect of pharmacist consultation on medication adherence was significantly greater than the single equation probit. The effect increased from 7% to 30% (p<0.010 after controlling for endogeneity bias. Conclusion: After appropriate adjustment for endogeneity bias, patients satisfied with their pharmacy services are substantially more likely to adhere to their medication. The results have important policy implications given the increasing focus

  16. High medical consultation rates of lead workers after industrial dispute over lead effects

    Energy Technology Data Exchange (ETDEWEB)

    Araki, S.; Murata, K.; Yanagihara, S.; Ushio, K.

    1982-02-01

    Medical consultation rates were compared between a group of lead workers (346 males) and two groups of non-lead workers (317 and 329 males) in a newspaper company where a serious industrial dispute took place over health effects of lead three years before this study. The comparison was also made within the group of lead workers. Maximal blood lead concentrations (PbBs) ranged from 0.1 mumol/kg to 3.6 mumol/kg (74 microgram/100 g) with an average of 1.3 mumol/kg in the past three years. Ages averaged 35 years in lead workers, and 34 and 30 years in non-lead workers, the ranges being 19-55 years in all. The consultation rate of lead workers was significantly higher than that of both the non-lead workers (P less than 0.001), when the number of workers who consulted physicians or dentists once or more for a year per 100 workers (general consultation rate) was compared. Disease-specific consultation rates were also higher in lead workers for seven categories of diseases and injuries such as hypertensive disease and peptic ulcers. When lead workers were divided into three groups by PbB or erythrocytes delta-aminolevulinic acid dehydratase (ALAD) levels, however, no significantly high rate was found in the higher PhB groups not lower ALAD groups in terms of general and disease-specific consultation rates. It was concluded that the industrial dispute might have been a major cause of the high consultation rate of lead workers.

  17. The role of process analysis and expert consultation in implementing an electronic medical record solution for multidrug-resistant tuberculosis

    Directory of Open Access Journals (Sweden)

    Rubeshan Perumal

    2014-03-01

    Full Text Available Background: Process analysis and expert consultation help streamline and optimise processes, but these are underutilised. The World Health Organisation (WHO recommends migration to electronic data collection by 2015, partly in response to multidrug-resistant tuberculosis (MDR-TB. We explore the influence of process analysis and iterative expert consultation, on shaping health information solutions to MDR-TB programmes.Methods: The study employs a two phase design. Phase one involves a process analysis of the South African National Tuberculosis Programme and an electronic medical records (EMR solution and the generation of a detailed process model grounded in the fit between individual task and technology (FITT theoretical framework using ‘business process modelling notation’. Phase two involves a two round Delphi study in the clinical management of tuberculosis and implementers of EMR solutions. Expert opinion is analysed according to emergent thematic content. Analyses and graphical model representation are performed using Microsoft Excel® and Visio® software.Results: A detailed process model is constructed which reveals 54 break points, 12 gaps, 3 risks, 5 wastes. Five participants are included in the Delphi study which support the findings of the process analysis. Thematic analysis identifies five themes: the individual, the process, technology, capacity, and collaboration. The opportunity to include synergistic relations across programmes emerges as a strong theme.Conclusions: Overall, the findings highlight inefficiencies, risk and gaps in the current process and the need for an operational excellence intervention. The study demonstrated the value of process engineering with iterative expert consultation toward developing a meaningful EMR solution consultation in a resource constrained, developing world context.

  18. Consultation Dilemma Catatonia in a Patient with Prior TBI: MentaI or Medical Disorder?

    Science.gov (United States)

    Khalafian, Andrey; Dukes, Charles; Tucker, Phebe

    2015-08-01

    Mr. R, a 27 year old Hispanic male with history of traumatic brain injury (TBI) over ten years prior but no psychiatric history, presents to the psychiatric consultation service with recent onset of mutism, psychotic behavior and new diagnosis of epilepsy. The differential diagnosis is broad and includes both medical and psychiatric causes: post-ictal state, non-convulsive status epilepticus, delirium due to metabolic conditions, drugs, catatonia, conversion disorder, major depression with psychotic features, new onset schizophrenia or a combination of these possible diagnoses. We explore different medical causes that can present with symptoms of catatonia, as it is crucial to rule out a possible treatable medical cause.

  19. The process of patient enablement in general practice nurse consultations: a grounded theory study.

    Science.gov (United States)

    Desborough, Jane; Banfield, Michelle; Phillips, Christine; Mills, Jane

    2017-05-01

    The aim of this study was to gain insight into the process of patient enablement in general practice nursing consultations. Enhanced roles for general practice nurses may benefit patients through a range of mechanisms, one of which may be increasing patient enablement. In studies with general practitioners enhanced patient enablement has been associated with increases in self-efficacy and skill development. This study used a constructivist grounded theory design. In-depth interviews were conducted with 16 general practice nurses and 23 patients from 21 general practices between September 2013 - March 2014. Data generation and analysis were conducted concurrently using constant comparative analysis and theoretical sampling focussing on the process and outcomes of patient enablement. Use of the storyline technique supported theoretical coding and integration of the data into a theoretical model. A clearly defined social process that fostered and optimised patient enablement was constructed. The theory of 'developing enabling healthcare partnerships between nurses and patients in general practice' incorporates three stages: triggering enabling healthcare partnerships, tailoring care and the manifestation of patient enablement. Patient enablement was evidenced through: 1. Patients' understanding of their unique healthcare requirements informing their health seeking behaviours and choices; 2. Patients taking an increased lead in their partnership with a nurse and seeking choices in their care and 3. Patients getting health care that reflected their needs, preferences and goals. This theoretical model is in line with a patient-centred model of health care and is particularly suited to patients with chronic disease. © 2016 John Wiley & Sons Ltd.

  20. The Significance of Asthma Follow-Up Consultations for Adherence to Asthma Medication, Asthma Medication Beliefs, and Asthma Control

    Directory of Open Access Journals (Sweden)

    Malin Axelsson

    2015-01-01

    Full Text Available Objective. The aim was to investigate adherence to asthma medication treatment, medication beliefs, and asthma control in relation to asthma follow-up consultations in asthmatics in the general population. A further aim was to describe associations between adherence, medication beliefs, and asthma control. Method. In the population-based West Sweden Asthma Study, data allowing calculation of adherence for 4.5 years based on pharmacy records were obtained from 165 adult asthmatics. Additional data were collected through questionnaires and structured interviews. Results. The mean adherence value for filled prescriptions for regular asthma medication was 68% (median 55.3% but varied over the year under study. Adherence to combination inhalers with corticosteroids and long-acting beta2 agonists was higher than adherence to single inhalers with corticosteroids only. More than one-third of participants reported not having seen an asthma nurse or physician for several years. Regular asthma follow-up consultations were associated with both higher adherence and the belief that asthma medication was necessary but were not associated with asthma control. Conclusions. Adherence to asthma medication treatment was low and varied over the year under study. The current study suggests that quality improvements in asthma care are needed if adherence to asthma medication is to be improved.

  1. [Consultation per video-conferencing with regional hospitals: the MEDKOM project of the Hannover Medical University].

    Science.gov (United States)

    Link, H; Poliwoda, H

    1999-01-01

    Consultations between doctors are necessary tools for decisions in diagnosis and treatment of patients. The mainstay is a sound communication between the participants, using verbal and audio-visual means. Usually clinical findings and imaging results are included. Using video technology with ISDN (integrated services digital network), such consulting can be performed across any distance. The department of hematology and oncology of the Medical School Hanover has introduced such a system in 1989 for conferencing with 12 regional hospitals and two private practices. It is now a well recognized and established system being applied for 270 sessions and for 1100 Patients per year. It is an integrated part of the co-operation, also allows medical education and quality improvement.

  2. Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

    Science.gov (United States)

    Brata, Cecilia; Fisher, Colleen; Marjadi, Brahmaputra; Schneider, Carl R; Clifford, Rhonda M

    2016-05-13

    Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

  3. Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school

    Directory of Open Access Journals (Sweden)

    Kemmy Julie

    2011-08-01

    Full Text Available Abstract Background Good communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences. Methods A structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5. 2519 questionnaires were returned in total. Results Students rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session: • how to structure the consultation • importance of patient-centredness • aspects of professionalism (including recognising own limits, being prepared, generally acting professionally. All years also noted that the sessions had increased their confidence, particularly through practice. Conclusions Our results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism.

  4. Grounded theory in medical education research: AMEE Guide No. 70.

    Science.gov (United States)

    Watling, Christopher J; Lingard, Lorelei

    2012-01-01

    Qualitative research in general and the grounded theory approach in particular, have become increasingly prominent in medical education research in recent years. In this Guide, we first provide a historical perspective on the origin and evolution of grounded theory. We then outline the principles underlying the grounded theory approach and the procedures for doing a grounded theory study, illustrating these elements with real examples. Next, we address key critiques of grounded theory, which continue to shape how the method is perceived and used. Finally, pitfalls and controversies in grounded theory research are examined to provide a balanced view of both the potential and the challenges of this approach. This Guide aims to assist researchers new to grounded theory to approach their studies in a disciplined and rigorous fashion, to challenge experienced researchers to reflect on their assumptions, and to arm readers of medical education research with an approach to critically appraising the quality of grounded theory studies.

  5. Searching for a written patient feedback instrument for patient-medical student consultations.

    Science.gov (United States)

    Hogan, Nicola; Li, Henry; Pezaro, Carmel; Roberts, Noel; Schmidt, Erica; Martin, Jenepher

    2017-01-01

    The Patient Teaching Associate (PTA) program at Eastern Health Clinical School uses volunteer patients with chronic illnesses in consultation-based medical student education. The PTA program aims to develop students' patient-centeredness and associated skills. Our study aims, 1) to identify key desirable characteristics of written patient feedback to doctors and/or students that focuses on patient-centeredness in consultations, and 2) to critically evaluate existing instruments to identify any suitable instrument for use for medical student teaching. We reviewed our experience with the PTA program and explored the literature on patient-centeredness and patient feedback to identify desirable characteristics of written feedback for our program. A systematic search was conducted to identify existing patient feedback instruments. These were then evaluated in light of criteria based on desirable characteristics. Eight instruments met the inclusion criteria. While all were designed for patient use, none were ideal for the PTA program. The Doctors' Interpersonal Skills Questionnaire (DISQ), while not used with medical students, is the closest fit to criteria. The lack of instruments specifically designed for written patient feedback to medical students highlights a gap in the current literature. The DISQ provides a good basis for developing a new feedback instrument focused on patient-centeredness in medical students.

  6. A system for medical consultation and education using multimodal human/machine communication.

    Science.gov (United States)

    Akay, M; Marsic, I; Medl, A; Bu, G

    1998-12-01

    Recent developments in networking and computing have enabled collaborative biomedical engineering research by geographically separated participants. One of the most promising goals is to use these technologies to extend human intellectual capabilities in medical decision making. These emerging technologies are poised to drastically reduce healthcare cost by providing service at remote locations. This also increases diagnosis capacity since information is made available to experts at any location. In this paper, we propose a novel application of a recently developed interactive and distributed system in medical consultation and education. Our approach builds on the notion that interactive and distributive capabilities of the system are crucial for medical consultation and education. The presented application uses a multiuser, collaborative environment with multimodal human/machine communication in the dimensions of sight, sound, and touch. The experimental setup, consisting of two user stations, and the multimodal interfaces, including sight (eye-tracking), sound (automatic speech), and touch (microbeam pen), were tested and evaluated. The system uses a collaborative workspace as a common visualization space. Users communicate with the application through a fusion agent by eye-tracking, speech, and microbeam pen. The audio/video teleconferencing is also included to help the radiologists to communicate with each other simultaneously while they are working on the mammograms. The system used in this study has three software agents: a fusion agent, a conversational agent, and an analytic agent. The fusion agent interprets multimodal commands by integrating the multimodal inputs. The conversational agent answers the user's questions and detects human-related or semantic errors and notifies the user about the results of the image analysis. The analytic agent enhances the digitized images using the wavelet denoising algorithm if requested by the user. To show how well the

  7. Referral and consultation communication between primary care and specialist physicians: finding common ground.

    Science.gov (United States)

    O'Malley, Ann S; Reschovsky, James D

    2011-01-10

    Communication between primary care physicians (PCPs) and specialists regarding referrals and consultations is often inadequate, with negative consequences for patients. We examined PCPs' and specialists' perceptions of communication regarding referrals and consultations. We then identified practice characteristics associated with reported communication. We analyzed the nationally representative 2008 Center for Studying Health System Change Health Tracking Physician Survey of 4720 physicians providing at least 20 hours per week of direct patient care. Outcome measures were physician reports of communication regarding referrals and consultations. Perceptions of communication regarding referrals and consultations differed. For example, 69.3% of PCPs reported "always" or "most of the time" sending notification of a patient's history and reason for consultation to specialists, but only 34.8% of specialists said they "always" or "most of the time" received such notification. Similarly, 80.6% of specialists said they "always" or "most of the time" send consultation results to the referring PCP, but only 62.2% of PCPs said they received such information. Physicians who did not receive timely communication regarding referrals and consultations were more likely to report that their ability to provide high-quality care was threatened. The 3 practice characteristics associated with PCPs and specialists reporting communication regarding referrals and consultations were "adequate" visit time with patients, receipt of quality reports regarding patients with chronic conditions, and nurse support for monitoring patients with chronic conditions. These modifiable practice supports associated with communication between PCPs and specialists can help inform the ways that resources are focused to improve care coordination.

  8. Undergraduate Rural Medical Education Program Development: Focus Group Consultation with the NRHA Rural Medical Educators Group

    Science.gov (United States)

    Downey, Laura H.; Wheat, John R.; Leeper, James D.; Florence, Joseph A.; Boulger, James G.; Hunsaker, Matt L.

    2011-01-01

    Context: Over a decade ago, leaders in rural medical education established the Rural Medical Educators (RME) Group, an interest group within the National Rural Health Association, to support faculty in rural medical education programs. This group has convened an annual RME conclave since 2006. In 2008, this conclave convened 15 national leaders in…

  9. Medical consultations in relation to severity of hand eczema in the general population

    DEFF Research Database (Denmark)

    Hald, M.; Berg, N.D.; Elberling, J.

    2008-01-01

    Background Hand eczema is a common disease with a wide severity spectrum. Little information exists concerning the association between the severity of hand eczema and medical consultations. Objectives To describe the self-rated severity of hand eczema in a general population and the relationship...... to seeking medical attention. Methods A questionnaire on self-reported hypersensitivity including two questions on hand eczema was sent to a random sample of 6000 individuals, aged 18-69 years, living in Copenhagen, Denmark. A total of 4242 individuals (71%) answered the questionnaire. All individuals who...... reported hand eczema (n = 752) within the previous 12 months received a more detailed questionnaire focused on hand eczema and a previously validated photographic guide with four groups of severity ranging from almost clear to very severe. Results Five hundred and sixty-four individuals (75%) returned...

  10. Making sense of grounded theory in medical education.

    Science.gov (United States)

    Kennedy, Tara J T; Lingard, Lorelei A

    2006-02-01

    Grounded theory is a research methodology designed to develop, through collection and analysis of data that is primarily (but not exclusively) qualitative, a well-integrated set of concepts that provide a theoretical explanation of a social phenomenon. This paper aims to provide an introduction to key features of grounded theory methodology within the context of medical education research. In this paper we include a discussion of the origins of grounded theory, a description of key methodological processes, a comment on pitfalls encountered commonly in the application of grounded theory research, and a summary of the strengths of grounded theory methodology with illustrations from the medical education domain. The significant strengths of grounded theory that have resulted in its enduring prominence in qualitative research include its clearly articulated analytical process and its emphasis on the generation of pragmatic theory that is grounded in the data of experience. When applied properly and thoughtfully, grounded theory can address research questions of significant relevance to the domain of medical education.

  11. The University Hospital Zurich Offers a Medical Online Consultation Service for Men With Intimate Health Problems.

    Science.gov (United States)

    Schmidt-Weitmann, Sabine; Schulz, Urs; Schmid, Daniel Max; Brockes, Christiane

    2017-05-01

    The University Hospital of Zurich offers a text-based, Medical Online Consultation Service to the public since 1999. Users asked health questions anonymously to tele-doctors. This study focused on the characteristics of male enquirers with intimate health problems, the content of their questions, the medical advice given by tele-doctors and the rating of the service to prove the benefit of an online service for medical laymen. This retrospective study included 5.1% of 3,305 enquiries from 2008 to 2010 using the International Classification of Diseases-10 and International Classification of Primary Care codes relevant for intimate and sexual health problems in men. A professional text analysis program (MAXQDA) supported the content analysis, which is based on the procedure of inductive category development described by Mayring. The average age was 40 years, 63.1% enquirers had no comorbidity, in 62.5% it was the first time they consulted a doctor, and 70.2% asked for a specific, single, intimate health issue. In 64.3%, the most important organ of concern was the penis. Overall, 30.4% asked about sexually transmitted diseases. In 74.4% a doctor visit was recommended to clarify the health issue. The rating of the problem solving was very good. The service was mainly used by younger men without comorbidity and no previous contact with a doctor with regard to an intimate health problem. The anonymous setting of the teleconsultation provided men individual, professional medical advice and decision support. Teleconsultation is suggested to empower patients by developing more health literacy.

  12. A doctor’s argument by authority: An analytical and empirical study of strategic manoeuvring in medical consultation

    NARCIS (Netherlands)

    Pilgram, R.

    2015-01-01

    In medical consultation, a doctor can appeal to his medical knowledge or expertise as a sign of the acceptability of his diagnosis, prognosis and/or advice ("It’s best to take these loratadine tablets, because I have seen them work really well against hay fever"). This could be quite convincing, as

  13. A doctor’s argument by authority: An analytical and empirical study of strategic manoeuvring in medical consultation

    NARCIS (Netherlands)

    Pilgram, R.

    2015-01-01

    In medical consultation, a doctor can appeal to his medical knowledge or expertise as a sign of the acceptability of his diagnosis, prognosis and/or advice ("It’s best to take these loratadine tablets, because I have seen them work really well against hay fever"). This could be quite convincing, as

  14. CAPITAL STRUCTURE ANALYSIS OF THE MEDICAL DIAGNOSTIC-CONSULTATIVE CENTERS IN VARNA (absolute indicators

    Directory of Open Access Journals (Sweden)

    Lyubomira Koeva-Dimitrova

    2016-08-01

    Full Text Available The capital structure analysis of medical institutions is related to the assessment of their financial sustainability. The degree of their financial sustainability indicates the extent to which the medical institution is exposed to financial risk. This financial risk is related to the use of foreign capital (debts, loans, etc. and it is defined as the probability of insolvency and possible bankruptcy due to the existence of debts which could not be repaid at some point in the foreseeable future. Objective: To analyze the capital structure of the medical diagnostic-consultative centers in Varna city and on this basis to assess their long-term solvency and existence of financial risk. Materials and Methods: The materials for the study are the published annual financial statements (up to 05. 01. 2016 in the Commercial Register for the period from year 2008 to 2014 of all MDCCs (Medical Diagnostic Consultative centers, registered in Varna - 9 in total. In the study are applied logical-mathematical methods (comparison, grouping, detail, graphical method; financial and accounting analysis (balance sheet analysis; analysis of absolute ratios for financial sustainability. Results: Upon analysis of the capital structure of MDCC's are studied the main absolute indicators characterizing the conditions for financial sustainability and the existence of financial risk regarding the solvency. A table represents the overall assessment of the degree of financial sustainability of the companies according to the type and structure of the fulfilled criteria. It was ascertained that for year 2014, DCC 3, 4, 5 and 8 have met all the conditions and according to them these hospitals have very high financial sustainability. DCC 7 has an average financial sustainability, DCC 1 and 2 are in a financial crisis and DCC 6 and 9 are facing bankruptcy. It must be emphasized that nearly half of the studied health care organizations (DCC 1, 2, 6 and 9 need urgent intervention by

  15. Physician-to-physician consultation via electronic mail: the Walter Reed Army Medical Center Ask a Doc system.

    Science.gov (United States)

    Abbott, Kevin C; Mann, Scott; DeWitt, Daisy; Sales, Linda Youngblood; Kennedy, Sean; Poropatich, Ron K

    2002-03-01

    Physician-to-physician consultation and discussion have traditionally been conducted by telephone, paper, and "curbside" (face to face meetings). The implementation and use of physician-to-physician consultation via electronic mail in a military health care system has not been reported previously. The group mail function of the Composite Health Care System, the main outpatient medical automation system for the Department of Defense, was modified to create mailgroups for every specialty of the Walter Reed Army Medical Center to facilitate ease of physician-to-physician consultation. This modification was called the "Ask a Doc" system. The system was deployed to a 21-state health care network among triservice participants. There were 3,121 consultations logged from April 22, 1998, to December 31, 2000. Growth in use expanded initially and was sustained during a 3-year period. Average response time to consultations was less than 1 day (11.93 hours). Additional training and maintenance requirements were minimal. In general, the use of electronic consultation mirrored that of clinical practice. Most specialty consultations involved the disciplines of internal medicine. Use of the Ask a Doc system was representative of total clinical workload and increased access to specialty medical care over a wide geographic area. The distribution of use indicated that user statistics were legitimate, and quality improvement programs could easily troubleshoot the system. Ask a Doc was inserted into a regional health care network with minimal cost to support and implement and was sustained with very little effort for 3 years. Barriers to even wider use currently include lack of secure communications and the difficulty in assigning workload credit for electronic consultations.

  16. [Problems in the transmission of information during within-hospital medical consultations and referrals].

    Science.gov (United States)

    Montero Ruiz, E; Rebollar Merino, Á; Melgar Molero, V; Barbero Allende, J M; Culebras López, A; López Álvarez, J

    2014-01-01

    Within-hospital medical consultations and referrals (MCR) have many problems, among them are those related to the oral and written transmission of information. Our aim is to analyze problems in the transmission of information related to MCR, and possible differences between medical (MS) and surgical (SS) services. A prospective, observational study was conducted on the MCR requested to Internal Medicine Service over an 8 month period. The following variables were collected: age, sex, the requester, MCR type, type of admission, comorbidity, hospital stay and mortality, length of MCR, the number of physicians responsible for the patient requesting service during the MCR, MCR repeats, information on the request, available medical records, verbal contact, conflict between doctors, and medical information in the discharge summary. Of the total 215 MCR received, 66 (30.7%) were requested by MS, and 149 (69.3%) per SS. MCR duration was 3 days (standard deviation [SD] 4.8. The number of doctors responsible was 1.7 (SD 1.1), with, Repeats 43 (20%) and Urgent 14 (6.5%). Minimum information on the request, 6 (9.1%) MS and 21 (27.5%) SS. Low availability of medical record, 2 (3%) MS and 50 (33.6%) SS. No verbal contact, 33 (15.4%). Conflict between doctors 13 (6%). Information acceptably good in MCR urgent request 100% MS, and 80% SS. Two out of three MCR were without reference to the discharge report. There are significant losses in the transmission of information during the process of the MCR, which is higher in surgical than in medical departments. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  17. A preliminary mixed-method investigation of trust and hidden signals in medical consultations.

    Directory of Open Access Journals (Sweden)

    Silvia Riva

    Full Text Available BACKGROUND: Several factors influence patients' trust, and trust influences the doctor-patient relationship. Recent literature has investigated the quality of the personal relationship and its dynamics by considering the role of communication and the elements that influence trust giving in the frame of general practitioner (GP consultations. OBJECTIVE: We analysed certain aspects of the interaction between patients and GPs to understand trust formation and maintenance by focusing on communication channels. The impact of socio-demographic variables in trust relationships was also evaluated. METHOD: A cross-sectional design using concurrent mixed qualitative and quantitative research methods was employed. One hundred adults were involved in a semi-structured interview composed of both qualitative and quantitative items for descriptive and exploratory purposes. The study was conducted in six community-based departments adjacent to primary care clinics in Trento, Italy. RESULTS: The findings revealed that patients trusted their GP to a high extent by relying on simple signals that were based on the quality of the one-to-one communication and on behavioural and relational patterns. Patients inferred the ability of their GP by adopting simple heuristics based mainly on the so-called social "honest signals" rather than on content-dependent features. Furthermore, socio-demographic variables affected trust: less literate and elderly people tended to trust more. CONCLUSIONS: This study is unique in attempting to explore the role of simple signals in trust relationships within medical consultation: people shape trust and give meaning to their relationships through a powerful channel of communication that orbits not around words but around social relations. The findings have implications for both clinicians and researchers. For doctors, these results suggest a way of thinking about encounters with patients. For researchers, the findings underline the

  18. Pharmacist-based Donepezil Outpatient Consultation Service to improve medication persistence

    Directory of Open Access Journals (Sweden)

    Watanabe N

    2012-08-01

    Full Text Available Norio Watanabe,1,2 Keiko Yamamura,3 Yusuke Suzuki,4 Hiroyuki Umegaki,4 Katsuro Shigeno,5 Ryo Matsushita,1 Yoshimichi Sai,1 Ken-ichi Miyamoto,1 Kiyofumi Yamada61Department of Clinical Pharmacy, Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa, Ishikawa, Japan; 2Department of Pharmacy, Hashima Municipal Hospital, Hashima, Gifu, Japan; 3Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 4Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; 5Department of Pharmacy Practice and Sciences, School of Pharmacy, Aichi Gakuin University, Nagoya, Aichi, Japan; 6Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Aichi, JapanAim: Donepezil is widely used to delay the progression of cognitive dysfunction in patients with Alzheimer's disease (AD, but the efficacy of pharmacotherapy is often reduced by poor adherence to medication. In order to improve adherence by providing information about AD and the significance of pharmacotherapy, the Donepezil Outpatient Consultation Service (DOCS was set up. The influence of this service on medication persistence was assessed in the present study.Methods: Among outpatients starting donepezil therapy, we enrolled 59 patients between April 2008 and September 2010 before establishment of the DOCS (non-DOCS group and 52 patients between October 2010 and March 2012 who attended the DOCS (DOCS group. Each patient's and their caregiver's understanding about the clinical features of AD and pharmacotherapy with donepezil were also assessed. Their understanding was compared before and after the DOCS, and the 1-year medication persistence rate and the reasons for discontinuation were also investigated.Results: The 1-year medication persistence rate was significantly higher in the DOCS group than in the non-DOCS group (73

  19. Does well-child care education improve consultations and medication management for childhood fever and common infections? A systematic review.

    Science.gov (United States)

    Peetoom, Kirsten K B; Smits, Jacqueline J M; Ploum, Luc J L; Verbakel, Jan Y; Dinant, Geert-Jan; Cals, Jochen W L

    2017-03-01

    Fever is common in preschool children and is often caused by benign self-limiting infections. Parents' lack of knowledge and fever phobia leads to high healthcare consumption. To systematically review the effect of providing educational interventions about childhood fever and common infections in well-child clinics (WCCs), prior to illness episodes, on parental practices: healthcare-seeking behaviour (frequency of physician consultations, appropriateness of consultations) and medication management. Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science were searched. We included randomised controlled trials evaluating interventions in WCC settings focusing on educating parents prior to new illness episodes to improve parental practices during episodes of childhood fever and common infections. Data were extracted on study design, sample characteristics, type of intervention, outcome measures and results. Eight studies were eligible for data extraction. Educating parents, in WCCs, prior to new episodes of childhood fever and common infections reduces daytime physician consultations of parents, home visits and telephone consultations, and enhances medication management. However, single and multicomponent interventions vary in effectiveness in reducing the frequency of daytime physician consultations and differ in their potential to reduce the number of home visits and general practitioner out-of-hours contacts. Only multicomponent interventions achieved a reduction in telephone consultations and improved medication management. Educating parents in WCCs prior to episodes of childhood fever and common infections showed potential to improve parental practices in terms of healthcare-seeking behaviour and medication management. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  20. Edward D. Churchill as a combat consultant: lessons for the senior visiting surgeons and today's military medical corps.

    Science.gov (United States)

    Cannon, Jeremy W; Fischer, Josef E

    2010-03-01

    In World War II, Edward D. Churchill volunteered as a combat consultant. In this role, he mentored many junior surgeons and challenged the Army leadership to treat hemorrhagic shock with blood rather than plasma. These lessons have continued relevance for today's Senior Visiting Surgeons and our military medical corps.

  1. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    DEFF Research Database (Denmark)

    Malling, Bente Vigh; Mortensen, Lene Sundahl; Scherpbier, Albert J J;

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate...... in clinical departments and the leadership skills of clinical consultants responsible for education....

  2. A qualitative study of caregivers' expectations and communication desires during medical consultation for sick children in Uganda.

    NARCIS (Netherlands)

    Kiguli, S.; Mafigiri, D.; Nakigudde, J.; Dalen, J. Van; Vleuten, C.P.M. van der

    2011-01-01

    OBJECTIVE: Little data exist on patients' expectations and communication desires during medical consultation in Non-Western settings. We conducted a qualitative study to compare expectations and communication desires of sick children's caregivers at Mulago Hospital, Uganda, to those of patients in W

  3. Coding patient emotional cues and concerns in medical consultations: the Verona coding definitions of emotional sequences (VR-CoDES).

    NARCIS (Netherlands)

    Zimmermann, C.; Piccolo, L. del; Bensing, J.; Bergvik, S.; Haes, H. de; Eide, H.; Fletcher, I.; Goss, C.; Heaven, C.; Humphris, G.; Young-Mi, K.; Langewitz, W.; Meeuwesen, L.; Nuebling, M.; Rimondini, M.; Salmon, P.; Dulmen, S. van; Wissow, L.; Zandbelt, L.; Finset, A.

    2011-01-01

    Objective: To present the Verona Coding Definitions of Emotional Sequences (VR-CoDES CC), a consensus based system for coding patient expressions of emotional distress in medical consultations, defined as Cues or Concerns. Methods: The system was developed by an international group of communication

  4. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    DEFF Research Database (Denmark)

    Malling, Bente Vigh; Mortensen, Lene S.; Scherpbier, Albert J J

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate...... in clinical departments and the leadership skills of clinical consultants responsible for education....

  5. Patients’ receptiveness for Medical students during consultation in Out patient department of a teaching hospital in Karachi Pakistan

    OpenAIRE

    Laiq-uz-Zaman Khan, Muhammad; Jawaid, Masood; Hafeez, Kamran

    2013-01-01

    Objective: Patients’ attitude towards medical students’ presence during treatment depends on the cultural values of the society. This study was conducted to find out the patients’ receptiveness in our society to be involved in teaching process for medical students during consultation in out patient department of a teaching hospital in Karachi Pakistan. Methodology: This cross sectional study was conducted in the surgical Out Patient Department (OPD) at Dow University Hospital from May 2012 to...

  6. Shuttle Ground Support Equipment (GSE) T-0 Umbilical to Space Shuttle Program (SSP) Flight Elements Consultation

    Science.gov (United States)

    Wilson, Timmy R.; Kichak, Robert A.; McManamen, John P.; Kramer-White, Julie; Raju, Ivatury S.; Beil, Robert J.; Weeks, John F.; Elliott, Kenny B.

    2009-01-01

    The NASA Engineering and Safety Center (NESC) was tasked with assessing the validity of an alternate opinion that surfaced during the investigation of recurrent failures at the Space Shuttle T-0 umbilical interface. The most visible problem occurred during the Space Transportation System (STS)-112 launch when pyrotechnics used to separate Solid Rocket Booster (SRB) Hold-Down Post (HDP) frangible nuts failed to fire. Subsequent investigations recommended several improvements to the Ground Support Equipment (GSE) and processing changes were implemented, including replacement of ground-half cables and connectors between flights, along with wiring modifications to make critical circuits quad-redundant across the interface. The alternate opinions maintained that insufficient data existed to exonerate the design, that additional data needed to be gathered under launch conditions, and that the interface should be further modified to ensure additional margin existed to preclude failure. The results of the assessment are contained in this report.

  7. Appropriateness of gastrointestinal consultations for hospitalized patients in an academic medical center

    Directory of Open Access Journals (Sweden)

    Cohen M

    2010-01-01

    Full Text Available Background: Consultation of experts in the internal medicine or surgery subspecialties is needed in the hospitalized population according to decisions of the house staff. Sometimes the referrals are not justified, consuming time and money without a significant change in the patient outcome. Objectives: The aim of our retrospective study was to evaluate justification of consecutive referrals of hospitalized patients for gastroenterology consultation. Materials and Methods: Request for consultation was deemed not justified when at least one of the following parameters was found: No contribution to case management, discharge before consultation, cancellation at the last minute, and a recommendation for ambulatory management or surgery. Results: In August-September 2006, there were 232 requests for gastroenterology consultations. Of them 127 (54.7% were men. The average age was 64.13±20.33 years. Ninety-four (40.2% of the cases had been hospitalized because of other reasons than the consultation issue. Consultation was not justified in 60 patients (25.9%. Ambulatory management was a possibility in 151 cases (65.0%. Request for colonoscopy and gastrointestinal background disease were the only significant predictive factors for justification of consultation, P < 0.0001 for both. Conclusions: In one fourth of the cases, gastroenterology consultation was not justified according to our strict criteria.

  8. PS3-28: Telemedicine Specialty Consultation in a Medically Underserved Community

    Science.gov (United States)

    Palen, Ted; Bodily, Mike

    2010-01-01

    Background and Aims: During the current national health care reform discussions, health information technologies (HIT) are receiving a lot of attention as means of lowering health care costs, improving access to health care, reducing errors during the delivery of healthcare, and improving health outcomes. Patients in rural or medically underserved areas find it difficult to obtain and maintain adequate access to health care. Telemedicine (TM) services can exchange video and audio information between healthcare providers and patients in different locations. For individuals in rural communities TM may improve access to care through the use of novel care delivery models. We are conducting a proof of concept (POC) study to evaluate the use of TM consultation between a primary care clinic in a medically underserved region of southern Colorado and a specialty care (endocrinology) clinic in Denver. Methods: This is a prospective health services POC study. We are taking advantage of a “natural experiment,” the expansion of primary care services into a medically underserved area of southern Colorado, to examine the requirements for establishing TM services between a rural primary care clinic and metropolitan based specialists. Results: Technical requirements included establishing network capabilities (512 kbps ISDN, H.320), 2 Mbps IP (H.323 or SIP), wirelss LAN connection, encryption embedded transmissions (H.235 and IEEE 802.1 x authentication); and remote monitoring equipment (exam camera, ENT/otoscope, electronic digital audio stethoscope (frequency: 40 Hz–2000 Hz, response: 45 Hz–1.6 KHz). Legal requirements involved the review of both federal and state statutes governing the use of TM for patient care and geographical/population requirements. Billing and regulatory requirements entail ensuring the use of the correct CPT and modifiers codes for TM and making sure these are operational within the medical record. Establishing criteria to ensure patients are

  9. Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

    OpenAIRE

    Langley, G. R.; Till, J E

    1989-01-01

    To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relation...

  10. Exploring emerging learning needs: a UK-wide consultation on environmental sustainability learning objectives for medical education.

    Science.gov (United States)

    Walpole, Sarah C; Mortimer, Frances; Inman, Alice; Braithwaite, Isobel; Thompson, Trevor

    2015-12-24

    This study aimed to engage wide-ranging stakeholders and develop consensus learning objectives for undergraduate and postgraduate medical education. A UK-wide consultation garnered opinions of healthcare students, healthcare educators and other key stakeholders about environmental sustainability in medical education. The policy Delphi approach informed this study. Draft learning objectives were revised iteratively during three rounds of consultation: online questionnaire or telephone interview, face-to-face seminar and email consultation. Twelve draft learning objectives were developed based on review of relevant literature. In round one, 64 participants' median ratings of the learning objectives were 3.5 for relevance and 3.0 for feasibility on a Likert scale of one to four. Revisions were proposed, e.g. to highlight relevance to public health and professionalism. Thirty three participants attended round two. Conflicting opinions were explored. Added content areas included health benefits of sustainable behaviours. To enhance usability, restructuring provided three overarching learning objectives, each with subsidiary points. All participants from rounds one and two were contacted in round three, and no further edits were required. This is the first attempt to define consensus learning objectives for medical students about environmental sustainability. Allowing a wide range of stakeholders to comment on multiple iterations of the document stimulated their engagement with the issues raised and ownership of the resulting learning objectives.

  11. Making sense of medically unexplained symptoms in general practice: a grounded theory study.

    Science.gov (United States)

    Stone, Louise

    2013-06-01

    Background General practitioners often encounter patients with medically unexplained symptoms. These patients share many common features, but there is little agreement about the best diagnostic framework for describing them. Aims This study aimed to explore how GPs make sense of medically unexplained symptoms. Design Semi-structured interviews were conducted with 24 GPs. Each participant was asked to describe a patient with medically unexplained symptoms and discuss their assessment and management. Setting The study was conducted among GPs from teaching practices across Australia. Methods Participants were selected by purposive sampling and all interviews were transcribed. Iterative analysis was undertaken using constructivist grounded theory methodology. Results GPs used a variety of frameworks to understand and manage patients with medically unexplained symptoms. They used different frameworks to reason, to help patients make sense of their suffering, and to communicate with other health professionals. GPs tried to avoid using stigmatising labels such as 'borderline personality disorder', which were seen to apply a 'layer of dismissal' to patients. They worried about missing serious physical disease, but managed the risk by deliberately attending to physical cues during some consultations, and focusing on coping with medically unexplained symptoms in others. They also used referrals to exclude serious disease, but were wary of triggering a harmful cycle of uncoordinated care. Conclusion GPs were aware of the ethical relevance of psychiatric diagnoses, and attempted to protect their patients from stigma. They crafted helpful explanatory narratives for patients that shaped their experience of suffering. Disease surveillance remained an important role for GPs who were managing medically unexplained symptoms.

  12. Knowledge, attitude and awareness of speciality of oral and maxillofacial surgery amongst medical consultants of vadodara district in gujarat state.

    Science.gov (United States)

    Shah, Navin; Patel, Nameeta; Mahajan, Amit; Shah, Rishabh

    2015-03-01

    Aim of this study was to survey the knowledge, attitude and awareness of the subject of oral and maxillofacial surgery speciality amongst the consultants and practitioners of medicine in district of Vadodara. List of members of various specialities in medical faculty were obtained from Indian Medical Association, Baroda branch and staff members of medical colleges of Vadodara district. A questionnaire survey was made which was distributed and their options were noted. Surgical removal of third molar, oral submucous fibrosis and implants were the problems where oral surgeons were preferred. For maxillofacial trauma plastic surgeons and orthopaedic surgeons were preferred than oral surgeons. For maxillofacial pathology E.N.T surgeons were mostly preferred. There is low awareness regarding oral and maxillofacial surgery amongst the general practitioners and medical consultants in Vadodara district. Survey shows that our training needs to be upgraded and revamped so that our trainees (post graduates in oral surgery) and have a greater "hands-on" exposure during their postgraduate training. They will then be able to handle increasingly complex cases in a multispecialty setup when they graduate and earn the mutual respect of the medical and dental fraternity and also the general public. MBBS students during their dental postings should be made aware of the depth and scope of oral surgery branch.

  13. ANALYSIS OF PROPERTY STRUCTURE OF MEDICAL DIAGNOSTIC CONSULTATIVE CENTERS IN VARNA

    Directory of Open Access Journals (Sweden)

    Lyubomira Koeva-Dimitrova

    2016-06-01

    Full Text Available The production and financial performance of one company depend on the size of its assets and the aptness of the assets� proportion. The aim of this article is urged to make an external analysis of the asset structure of medical diagnostic and consultative centers (DCC in Varna and on this basis to draw conclusions regarding their property structure. Subject of the study is the annual financial statements, published in the Commercial Register, of all 9 in number DCCs that are registered in Varna. The names of DCC's are encoded with numbers from 1 to 9, with numbers from 1 to 7 are 6 DCCs, owned by the Municipality of Varna, one of them is a subsidiary of staterun hospital, with number 8 and 9 are private DCC's. Subject of the study are the assets and their proportion in the studied hospitals. The study covers 7 years - from year 2008 to year 2014. In the study are calculated and compared the indicators for intensity of the property as well as the relative share of the fixed assets obtained as an average value of the relative shares of all nine in number hospitals for the entire studied period. The following important conclusions have been made: 1 The average relative share of fixed assets of Varna DCCs for the period 2008 � 2014 is 56.85%. 2 The proportion of FA calculated only for municipal DCC's (average value is significantly higher - 72.75% compared to the overall average of 56.85%. 3 Private hospitals invest a lot less money in fixed assets than the municipal ones. 4 Since 2013 there is a slight increase of FA share in the private and the state-run DCC, and a slight decrease in the municipal ones (71.93. 5 The creation of an online database comprising of average indicators of the financial and property status of Bulgarian companies is essential and necessary condition for improving their competitiveness by providing reliable, accurate and usable information for comparison.

  14. The medical consultation viewed as a value chain: a neurobehavioral approach to emotion regulation in doctor-patient interaction.

    Science.gov (United States)

    Finset, Arnstein; Mjaaland, Trond A

    2009-03-01

    To present a model of the medical consultation as a value chain, and to apply a neurobehavioral perspective to analyze each element in the chain with relevance for emotion regulation. Current knowledge on four elements in medical consultations and neuroscientific evidence on corresponding basic processes are selectively reviewed. The four elements of communication behaviours presented as steps in a value chain model are: (1) establishing rapport, (2) patient disclosure of emotional cues and concerns, (3) the doctor's expression of empathy, and (4) positive reappraisal of concerns. The metaphor of the value chain, with emphasis on goal orientation, helps to understand the impact of each communicative element on the outcome of the consultation. Added value at each step is proposed in terms of effects on outcome indicators; in this case patients affect regulation. Neurobehavioral mechanisms are suggested to explain the association between communication behaviour and affect regulation outcome. The value chain metaphor and the emphasis on behaviour-outcome-mechanisms associations may be of interest as conceptualizations for communications skills training.

  15. [Bioclimatic consultation].

    Science.gov (United States)

    Cordes, H; Reinke, R

    1975-01-23

    The climatological environment may effect the human state of health, disadvantageously or favourably. This knowledge, confirmed by empiric as well as scientific research can be used by e.g. changing the place of residence towards a healthy and benefical climate. For a professional climatological planning of such a project the "Deutscher Wetterdienst" renders bioclimatic consultations within the Federal Republic of Germany. For this purpose individual reactions as well as state health of the person in question have to be considered. A method will be shown how to combine medical diagnostic facts and bioclimatic consultation.

  16. Towards a repository for standardized medical image and signal case data annotated with ground truth.

    Science.gov (United States)

    Deserno, Thomas M; Welter, Petra; Horsch, Alexander

    2012-04-01

    Validation of medical signal and image processing systems requires quality-assured, representative and generally acknowledged databases accompanied by appropriate reference (ground truth) and clinical metadata, which are composed laboriously for each project and are not shared with the scientific community. In our vision, such data will be stored centrally in an open repository. We propose an architecture for a standardized case data and ground truth information repository supporting the evaluation and analysis of computer-aided diagnosis based on (a) the Reference Model for an Open Archival Information System (OAIS) provided by the NASA Consultative Committee for Space Data Systems (ISO 14721:2003), (b) the Dublin Core Metadata Initiative (DCMI) Element Set (ISO 15836:2009), (c) the Open Archive Initiative (OAI) Protocol for Metadata Harvesting, and (d) the Image Retrieval in Medical Applications (IRMA) framework. In our implementation, a portal bunches all of the functionalities that are needed for data submission and retrieval. The complete life cycle of the data (define, create, store, sustain, share, use, and improve) is managed. Sophisticated search tools make it easier to use the datasets, which may be merged from different providers. An integrated history record guarantees reproducibility. A standardized creation report is generated with a permanent digital object identifier. This creation report must be referenced by all of the data users. Peer-reviewed e-publishing of these reports will create a reputation for the data contributors and will form de-facto standards regarding image and signal datasets. Good practice guidelines for validation methodology complement the concept of the case repository. This procedure will increase the comparability of evaluation studies for medical signal and image processing methods and applications.

  17. Scientific profile and professional responsibility of Court-appointed Medical Technical Consultants in Italy: time for a specific educational curriculum?

    Science.gov (United States)

    Conti, Andrea Alberto

    2014-08-20

    Court-appointed Technical Consultants (CTCs) are fundamental figures in the Italian judicial system. CTCs are experts appointed by judges in order to supplement their activities by ascertaining, collecting and analyzing facts concerning the specific subject of a lawsuit. These experts formulate opinions, gather motivations and perform checks to provide clear, objective and irrefutable answers to the questions posed by judges. With direct reference to the medical field, while police doctors (specialists in forensic medicine) follow an academic, dedicated, well-structured educational curriculum, the University specialty school in Forensic Medicine, other medical CTCs, though not infrequently luminaries with one or many medical specialties and professional acknowledgments, may have no specific legal-medicine and juridical expertise, precisely because a similar expertise is not formally required of them. In the light of these considerations, in Italy some professionals of the legal world, and of the health context too, have proposed for medical CTCs targeted educational pathways, which would provide these experts with formal specific qualifications. In synthesis and in conclusion, a full knowledge and a rigorous respect of the rules of legal proceedings emerge as increasingly important characteristics for current and future Court-appointed Technical Consultants, together with a specific educational curriculum.

  18. Overweight and obesitas: effect on GP consultation and the use of medication.

    NARCIS (Netherlands)

    Dijk, L. van; Otters, H.; Schuit, J.

    2004-01-01

    Background: Most research on health consequences of obesitas examined differences in occurrences of specific health problems such as diabetes mellitus and coronary heart disease and related use of care, rather than investigating differences in the use of care in general, such as rate GP consultation

  19. Cues and Concerns by Patients in Medical Consultations: A Literature Review

    Science.gov (United States)

    Zimmermann, Christa; Del Piccolo, Lidia; Finset, Arnstein

    2007-01-01

    The aim of the current article is to review the peer-reviewed research literature on cues and concerns published between 1975 and 2006. To be included, articles had to report observational studies based on patient-physician consultations and report findings on patient expressions of cues and/or concerns. Quantitative and qualitative studies from…

  20. Analysis of an electronic consultation program at an academic medical centre: Primary care provider questions, specialist responses, and primary care provider actions.

    Science.gov (United States)

    Wrenn, Katherine; Catschegn, Sereina; Cruz, Marisa; Gleason, Nathaniel; Gonzales, Ralph

    2017-02-01

    Introduction Electronic consultations (eConsults) increase access to specialty care, but little is known about the types of questions primary care providers (PCPs) ask through eConsults, and how they respond to specialist recommendations. Methods This is a retrospective descriptive analysis of the first 200 eConsults completed in the UCSF eConsult program. Participating PCPs were from eight adult primary care sites at the University of California, San Francisco (UCSF), USA. Medicine subspecialties participating were Cardiology, Endocrinology, Gastroenterology/hepatology, Hematology, Infectious diseases, Nephrology, Pulmonary medicine, Rheumatology, and Sleep medicine. We categorized eConsult questions into "diagnosis," "treatment," and/or "monitoring." We performed medical record reviews to determine the percentage of specialist recommendations PCPs implemented, and the proportion of patients with a specialist visit in the same specialty as the eConsult, emergency department visit, or hospital admission during the subsequent six months. Results PCP questions related to diagnosis in 71% of cases, treatment in 46%, and monitoring in 21%. Specialist responses related to diagnosis in 76% of cases, treatment in 64%, and monitoring in 40%. PCPs ordered 79% of all recommended laboratory tests, 86% of recommended imaging tests and procedures, 65% of recommended new medications, and 73% of recommended medication changes. In the six months after the eConsult, 14% of patients had a specialist visit within the UCSF system in the same specialty as the eConsult. Discussion eConsults provide guidance to PCPs across the spectrum of patient care. PCPs implement specialists' recommendations in the large majority of cases, and few patients subsequently require in-person specialty care related to the reason for the eConsult.

  1. Observed communication skills: how do they relate to the consultation content? A nation-wide study of graduate medical students seeing a standardized patient for a first-time consultation in a general practice setting

    Directory of Open Access Journals (Sweden)

    Holen Are

    2007-11-01

    Full Text Available Abstract Background In this study, we wanted to investigate the relationship between background variables, communication skills, and the bio-psychosocial content of a medical consultation in a general practice setting with a standardized patient. Methods Final-year medical school students (N = 111 carried out a consultation with an actor playing the role of a patient with a specific somatic complaint, psychosocial stressors, and concerns about cancer. Based on videotapes, communication skills and consultation content were scored separately. Results The mean level of overall communication skills had a significant impact upon the counts of psychosocial issues, the patient's concerns about cancer, and the information and planning parts of the consultation content being addressed. Gender and age had no influence upon the relationship between communication skills and consultation content. Conclusion Communication skills seem to be important for final-year students' competence in addressing sensitive psychosocial issues and patients' concerns as well as informing and planning with patients being representative for a fairly complex case in general practice. This result should be considered in the design and incorporation of communication skills training as part of the curriculum of medical schools.

  2. Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians.

    Science.gov (United States)

    Liénard, A; Merckaert, I; Libert, Y; Delvaux, N; Marchal, S; Boniver, J; Etienne, A-M; Klastersky, J; Reynaert, C; Scalliet, P; Slachmuylder, J-L; Razavi, D

    2006-09-01

    No study has yet assessed the impact of physicians' skills acquisition after a communication skills training programme on the evolution of patients' anxiety following a medical consultation. This study aimed to compare the impact, on patients' anxiety, of a basic communication skills training programme (BT) and the same programme consolidated by consolidation workshops (CW), and to investigate physicians' communication variables associated with patients' anxiety. Physicians, after attending the BT, were randomly assigned to CW or to a waiting list. The control group was not a non-intervention group. Consultations with a cancer patient were recorded. Patients' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation. Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual. No statistically significant change over time and between groups was observed. Mixed-effects modelling showed that a decrease in patients' anxiety was linked with screening questions (P = 0.045), physicians' satisfaction about support given (P = 0.004) and with patients' distress (P training programme was observed. This study shows the influence of some communication skills on the evolution of patients' anxiety. Physicians should be aware of these influences.

  3. Corridor consultations and the medical microbiological record: is patient safety at risk?

    OpenAIRE

    Heard, S R; Roberts, C; Furrows, S J; Kelsey, M.; Southgate, L

    2003-01-01

    The performance procedures of the General Medical Council are aimed at identifying seriously deficient performance in a doctor. The performance procedures require the medical record to be of a standard that enables the next doctor seeing the patient to give adequate care based on the available information. Setting standards for microbiological record keeping has proved difficult. Over one fifth of practising medical microbiologists (including virologists) in the UK (139 of 676) responded to a...

  4. Rural Inpatient Telepharmacy Consultation Demonstration for After-Hours Medication Review

    OpenAIRE

    Cole, Stacey L.; Grubbs, John H.; Din, Cathy; Nesbitt, Thomas S.

    2012-01-01

    Objective: Medication errors contribute to a significant number of fatal and nonfatal adverse medical events each year. Many actions, from both a policy and innovation standpoint, have been taken to reduce medication errors in the inpatient setting; yet, these actions often target larger urban hospitals. Rural hospitals face many more challenges in implementing these changes due to fewer resources and lower patient volumes. Our article discusses the implementation and results of a telephar...

  5. Teaching Psychology to Medical Students on a Consultation-Liaison Psychiatry Service.

    Science.gov (United States)

    Gabinet, Laille; And Others

    1984-01-01

    Practical advice on teaching skills which are essential, but difficult for many medical students to master, is presented. Topics covered include interviewing skills, the mental status examination, the use of psychotropic medication in the general hospital, psychodiagnostic techniques, and dealing with ward management problems. (RM)

  6. Consulting parents on childhood obesity and implications for medical student learning.

    Science.gov (United States)

    O'Keefe, Maree; Coat, Suzette

    2009-10-01

    It is important that medical schools take some account of community expectations for health care when planning curricula. This is particularly important for emerging public health problems such as childhood obesity. The aim of this study was to explore parent attitudes to the role of the doctor in childhood obesity and implications for medical student learning. The views of eight mothers and one father were explored through interview. Transcripts were analysed using an iterative process of theme identification and testing against transcript data. A range of recruitment strategies were used in an attempt to increase participant numbers. Participants believed doctors should support parent decisions about children's diet and life-style and be prepared to 'step-in' with a more active role when, in the parent's view, this was needed. Participants wanted doctors to provide advice on healthy nutrition, be proficient in child physical assessment and be able to communicate sensitively with both children and parents. Although the parents who agreed to be interviewed expressed views demonstrating their commitment to preventing and reducing childhood obesity, many other parents declined the invitation to contribute. It may be that parent concern within the broader community that childhood obesity is a real and significant health risk does not reflect the level of concern of the medical profession. The most likely implications for the teaching of medical students are a need for more comprehensive teaching around healthy diet and activity for all children, improved recognition of overweight and obesity and ongoing communication skills development.

  7. Utilizing uncoded consultation notes from electronic medical records for predictive modeling of colorectal cancer

    NARCIS (Netherlands)

    Hoogendoorn, Mark; Szolovits, Peter; Moons, Leon M G; Numans, ME

    2016-01-01

    OBJECTIVE: Machine learning techniques can be used to extract predictive models for diseases from electronic medical records (EMRs). However, the nature of EMRs makes it difficult to apply off-the-shelf machine learning techniques while still exploiting the rich content of the EMRs. In this paper, w

  8. Medical provider attitudes about behavioral health consultants in integrated primary care: a preliminary study.

    Science.gov (United States)

    Torrence, Nicole D; Mueller, Anne E; Ilem, Allison A; Renn, Brenna N; DeSantis, Brian; Segal, Daniel L

    2014-12-01

    Integrated behavioral health increases service utilization and treatment success, particularly with high-risk populations. This study assessed medical personnel's attitudes and perceptions of behavioral health clinicians (BHCs) in primary care using a brief self-report measure. A 6-item survey was given to medical providers (n = 45) from a health care system that includes integrated behavioral health services. Survey items assessed providers' attitudes and perceptions about BHCs. Attitudes about behavioral health were largely favorable. For all items, 73.3% to 100% of participants endorsed strongly agree or agree. Chi-square analyses revealed that those who interacted more frequently with BHCs were more comfortable discussing behavioral health issues with their patients, χ²(6, n = 45) = 13.43, p providers worked were not significantly related to any survey items. Medical providers surveyed believe that BHCs are valuable members of integrated health care, improving their abilities to provide care and to address their patients' physical and behavioral health problems. Although these preliminary results are promising, the setting surveyed has well-integrated behavioral health care services and thus might not be representative of other settings without such integration. Future studies should address medical providers' opinions of BHCs in a variety of settings with larger samples.

  9. Feedback on video recorded consultations in medical teaching: why students loathe and love it – a focus-group based qualitative study

    Directory of Open Access Journals (Sweden)

    Baerheim Anders

    2005-07-01

    Full Text Available Abstract Background Feedback on videotaped consultations is a useful way to enhance consultation skills among medical students. The method is becoming increasingly common, but is still not widely implemented in medical education. One obstacle might be that many students seem to consider this educational approach a stressful experience and are reluctant to participate. In order to improve the process and make it more acceptable to the participants, we wanted to identify possible problems experienced by students when making and receiving feedback on their video taped consultations. Methods Nineteen of 75 students at the University of Bergen, Norway, participating in a consultation course in their final term of medical school underwent focus group interviews immediately following a video-based feedback session. The material was audio-taped, transcribed, and analysed by phenomenological qualitative analysis. Results The study uncovered that some students experienced emotional distress before the start of the course. They were apprehensive and lacking in confidence, expressing fear about exposing lack of skills and competence in front of each other. The video evaluation session and feedback process were evaluated positively however, and they found that their worries had been exaggerated. The video evaluation process also seemed to help strengthen the students' self esteem and self-confidence, and they welcomed this. Conclusion Our study provides insight regarding the vulnerability of students receiving feedback from videotaped consultations and their need for reassurance and support in the process, and demonstrates the importance of carefully considering the design and execution of such educational programs.

  10. Explanatory Power for Medical Expert Systems: Studies in the Representation of Causal Relationships for Clinical Consultations,

    Science.gov (United States)

    1981-12-01

    Present Illness Program (PIP) and CADUCEUS , two recent medical reasoning programs, deal with the task of representing both cause-effect and effect-cause...information. CADUCEUS [15] has two numbers for each manifestation of disease, an "evoking strength" (the likelihood that an observed manifestation is...the inference weightings on effect-cause rules and cause-effect rules respectively. However, the first version of the CADUCEUS program (INTERNIST-1

  11. Making consultations run smoothly

    DEFF Research Database (Denmark)

    Jespersen, Astrid Pernille; Jensen, Torben Elgaard

    2012-01-01

    This article investigates the skilful use of time in general practice consultations. It argues that consultation work involves social and material interactions, which are only partially conceptualized in existing medical practice literatures. As an alternative, this article employs ideas from...... the field of science and technology studies (STS), including notions of relationality, multiplicity and otherness. Through this lens, and based on extensive fieldwork, it describes the daily work of arranging time before, during and after consultations. In conclusion, it suggests that a STS...

  12. Improving Community Understanding of Medical Research: Audience Response Technology for Community Consultation for Exception to Informed Consent

    Directory of Open Access Journals (Sweden)

    Taher Vohra

    2014-07-01

    Full Text Available Introduction: The Department of Health and Human Services and Food and Drug Administration described guidelines for exception from informed consent (EFIC research. These guidelines require community consultation (CC events, which allow members of the community to understand the study, provide feedback and give advice. A real-time gauge of audience understanding would allow the speaker to modify the discussion. The objective of the study is to describe the use of audience response survey (ARS technology in EFIC CCs. Methods: As part of the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART, 13 CC events were conducted. We prepared a PowerPoint™ presentation with 4 embedded ARS questions,according to specific IRB guidelines to ensure that the pertinent information would reach our targeted audience. During 6 CCs, an ARS was used to gauge audience comprehension. Participants completed paper surveys regarding their opinion of the study following each CC. Results: The ARS was used with minimal explanation and only one ARS was lost. Greater than 80% of the participants correctly answered 3 of the 4 ARS questions with 61% correctly answering the question regarding EFIC. A total of 105 participants answered the paper survey; 80-90% of the responses to the paper survey were either strongly agree or agree. The average scores on the paper survey in the ARS sites compared to the non-ARS sites were significantly more positive. Conclusion: The use of an audience response system during the community consultation aspects of EFIC is feasible and provides a real-time assessment of audience comprehension of the study and EFIC process. It may improve the community’s opinion and support of the study.

  13. Empowerment, motivation, and medical adherence (EMMA: the feasibility of a program for patient-centered consultations to support medication adherence and blood glucose control in adults with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Varming AR

    2015-09-01

    Full Text Available Annemarie Reinhardt Varming,1 Ulla Møller Hansen,1 Gudbjörg Andrésdóttir,2 Gitte Reventlov Husted,1 Ingrid Willaing1 1Patient Education Research, 2Complications Research, Steno Diabetes Center, Gentofte, Denmark Purpose: To explore the feasibility of a research-based program for patient-centered consultations to improve medical adherence and blood glucose control in patients with type 2 diabetes.  Patients and methods: The patient-centered empowerment, motivation, and medical adherence (EMMA consultation program consisted of three individual consultations and one phone call with a single health care professional (HCP. Nineteen patients with type 2 diabetes completed the feasibility study. Feasibility was assessed by a questionnaire-based interview with patients 2 months after the final consultation and interviews with HCPs. Patient participation was measured by 10-second event coding based on digital recordings and observations of the consultations.  Results: HCPs reported that EMMA supported patient-centered consultations by facilitating dialogue, reflection, and patient activity. Patients reported that they experienced valuable learning during the consultations, felt understood, and listened to and felt a trusting relationship with HCPs. Consultations became more person-specific, which helped patients and HCPs to discover inadequate diabetes self-management through shared decision-making. Compared with routine consultations, HCPs talked less and patients talked more. Seven of ten dialogue tools were used by all patients. It was difficult to complete the EMMA consultations within the scheduled time.  Conclusion: The EMMA program was feasible, usable, and acceptable to patients and HCPs. The use of tools elicited patients’ perspectives and facilitated patient participation and shared decision-making. Keywords: type 2 diabetes, adherence, participation, dialogue, health education, self-management

  14. How do lay people assess the quality of physicians' communicative responses to patients' emotional cues and concerns? An international multicentre study based on videotaped medical consultations.

    NARCIS (Netherlands)

    Mazzi, M.A.; Bensing, J.; Rimondini, M.; Fletcher, I.; Vliet, L. van; Zimmermann, C.; Deveugele, M.

    2013-01-01

    Objective: To establish which kind of physician communicative responses to patient cues and concerns are appreciated by lay people. Methods: A balanced sample (259 people) was recruited in public places to participate in a full day observation of four videotaped standardized medical consultations. I

  15. What should be given a priority - costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel.

    Science.gov (United States)

    Guttman, Nurit; Shalev, Carmel; Kaplan, Giora; Abulafia, Ahuva; Bin-Nun, Gabi; Goffer, Ronen; Ben-Moshe, Roei; Tal, Orna; Shani, Mordechai; Lev, Boaz

    2008-06-01

    In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care-related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. One hundred thirty-two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system's monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues.

  16. "Best care on home ground" versus "elitist healthcare": concerns and competing expectations for medical tourism development in Barbados.

    Science.gov (United States)

    Johnston, Rory; Adams, Krystyna; Bishop, Lisa; Crooks, Valorie A; Snyder, Jeremy

    2015-02-03

    Many countries have demonstrated interest in expanding their medical tourism sectors because of its potential economic and health system benefits. However, medical tourism poses challenges to the equitable distribution of health resources between international and local patients and private and public medical facilities. Currently, very little is known about how medical tourism is perceived among front line workers and users of health systems in medical tourism 'destinations'. Barbados is one such country currently seeking to expand its medical tourism sector. Barbadian nurses and health care users were consulted about the challenges and benefits posed by ongoing medical tourism development there. Focus groups were held with two stakeholder groups in May, 2013. Nine (n = 9) citizens who use the public health system participated in the first focus group and seven (n = 7) nurses participated in the second. Each focus group ran for 1.5 hours and was digitally recorded. Following transcription, thematic analysis of the digitally coded focus group data was conducted to identify cross-cutting themes and issues. Three core concerns regarding medical tourism's health equity impacts were raised; its potential to 1) incentivize migration of health workers from public to private facilities, 2) burden Barbados' lone tertiary health care centre, and 3) produce different tiers of quality of care within the same health system. These concerns were informed and tempered by the existing a) health system structure that incorporates both universal public healthcare and a significant private medical sector, b) international mobility among patients and health workers, and c) Barbados' large recreational tourism sector, which served as the main reference in discussions about medical tourism's impacts. Incorporating these concerns and contextual influences, participants' shared their expectations of how medical tourism should locally develop and operate. By engaging with local

  17. Negotiation strategies and patient empowerment in Spanish and British medical consultations.

    Science.gov (United States)

    Hernández-López, María de la O

    2011-01-01

    Making a decision is not only one of the physician's most important responsibilities but also one of patients' most sensitive moments in medical encounters. Drawing from pragmatics studies, this paper explores rapport maintenance and/or enhancement (Spencer-Oatey 2000, 2008) in the decision-making strategies that General Practitioners (GPs) and patients employ in 80 encounters in various areas of England and Spain. The results show that such strategies are context-bound and subject to role specifications: while patients may make use of (dis)agreement strategies and initiate decisions and/or self-diagnosis, doctors give options, show empathy, expand explanations or show explicit or implicit (dis) agreement. In relation to this, notable findings were revealed: first, these communicative strategies may vary not only in terms of frequency but also quality and distribution; second, the Spanish interlocutors in the data gathered tend to negotiate through the explicit expression of opinions, while the British interlocutors prefer the discussion of different alternatives and value the other's freedom to act. Third, there is higher tolerance of disagreement in the Spanish data. Fourth, negotiation may be undertaken on the basis of either self-affirmation or consensus-seeking beliefs. Finally, patient empowerment is displayed in divergent ways in both sets of data. In short, the decision-making processes examined are subject to social and psychological factors with a direct impact on communicative styles.

  18. Ontology driven decision support systems for medical diagnosis - an interactive form for consultation in patients with plasma cell disease.

    Science.gov (United States)

    Donfack Guefack, Valéry; Bertaud Gounot, Valérie; Duvauferrier, Régis; Bourde, Annabel; Morelli, John; Lasbleiz, Jérémy

    2012-01-01

    Multiple myeloma (MM) is a malignant disorder characterized by the monoclonal proliferation of B cell derived plasma cells in the bone marrow. The diagnosis depends on the identification of abnormal monoclonal marrow plasma cells, monoclonal protein in the serum or urine, evidence of end-organ damage, and a clinical picture consistent with MM. The distinction between MM stages- monoclonal gammopathy of undetermined significance or indolent myeloma-is critical in guiding therapy. This paper describes how to produce ontology-driven semiological rules base (SRB) and a consultation form to aid in the diagnosis of plasma cells diseases. We have extracted the MM sub-ontology from the NCI Thesaurus. Using Protégé 3.4.2 and owl1, criteria in the literature for the diagnosis and staging of MM have been added to the ontology. All quantitative parameters have been transformed to a qualitative format. A formal description of MM variants and stages has been given. The obtained ontology has been checked by a reasoner and instantiated to obtain a SRB. The form created has been tested and evaluated utilizing 63 clinical medical reports. The likelihood for a disease being the correct diagnosis is determined by computing a ratio. The resulting tool is relevant for MM diagnosis and staging.

  19. Non-verbal behaviour of patients with schizophrenia in medical consultations--a comparison with depressed patients and association with symptom levels.

    Science.gov (United States)

    Dimic, Sara; Wildgrube, Christiane; McCabe, Rosemarie; Hassan, Imren; Barnes, Thomas R E; Priebe, Stefan

    2010-01-01

    The Dutch psychiatrist Rümke introduced the notion that patients with schizophrenia could be recognised intuitively by an experienced psychiatrist, naming the process as the 'praecox feeling'. This feeling may reflect aspects of the non-verbal behaviour of patients as shown in a medical consultation. The aim of this study was to test whether aspects of the initial non-verbal behaviour of patients with schizophrenia and depression in medical consultations differ and are associated with symptom levels in each group. The first 2 min of videotaped outpatient consultations with 78 patients (39 each with schizophrenia and depression) were analysed by researchers who were masked to the diagnosis and symptom levels of the patients. Non-verbal behaviour was assessed using a modified Ethological Coding System for Interviews. Symptom levels were rated by independent researchers on the Positive and Negative Syndrome Scale and Beck Depression Inventory. The 2 diagnostic groups showed significant differences on 1 out of 6 aspects of non-verbal communication, with patients with schizophrenia exhibiting more 'flight' behaviour, i.e. more looking down or away, crouching and freezing. Within the group of patients with schizophrenia, more 'flight' and less 'assertion' were associated with higher symptom levels. Initial 'flight' behaviour of patients in medical consultations may be specific for schizophrenia and associated with the symptoms of that illness. Such behaviour might indicate an avoidance of potentially adverse communication, and future research should investigate whether it can also be identified in everyday social interactions other than medical consultations. Copyright (c) 2010 S. Karger AG, Basel.

  20. A informática no consultório médico Computing in medical practice

    Directory of Open Access Journals (Sweden)

    Rudolf Wechsler

    2003-06-01

    technology in both medical education and/or medical practice. SOURCES OF DATA: information was gathered through nonsystematic bibliographic review, including articles, official regulations, book chapters and annals. Direct search and search of electronic databanks in Medline and Lilacs databases were also performed. SUMMARY OF THE FINDINGS: this paper was structured in topics. First, there is a discussion on the electronic medical record. The following aspects are presented: history, functions, costs, benefits, ethical and legal issues, and positive and negative characteristics. Medical decision-support systems are also evaluated in view of the huge amount of information produced every year regarding healthcare. The impact of the Internet on the production and diffusion of knowledge is also analyzed. Telemedicine is assessed, since it presents new challenges to medical practice, and raises important ethical issues such as "virtual medical consultation". Finally, a practical experience of modernization of a pediatric outpatient center by the introduction of computers and telecommunication tools is described. CONCLUSIONS: medical computing offers tools and instruments that support the administrative organization of medical visits, gather, store and process patient's data, generate diagnoses, provide therapeutical advice and access to information in order to improve medical knowledge and to make it available whenever and wherever adequate decision-making is required.

  1. What Ethical Issues Really Arise in Practice at an Academic Medical Center? A Quantitative and Qualitative Analysis of Clinical Ethics Consultations from 2008 to 2013.

    Science.gov (United States)

    Wasson, Katherine; Anderson, Emily; Hagstrom, Erika; McCarthy, Michael; Parsi, Kayhan; Kuczewski, Mark

    2016-09-01

    As the field of clinical ethics consultation sets standards and moves forward with the Quality Attestation process, questions should be raised about what ethical issues really do arise in practice. There is limited data on the type and number of ethics consultations conducted across different settings. At Loyola University Medical Center, we conducted a retrospective review of our ethics consultations from 2008 through 2013. One hundred fifty-six cases met the eligibility criteria. We analyzed demographic data on these patients and conducted a content analysis of the ethics consultation write-ups coding both the frequency of ethical issues and most significant, or key, ethical issue per case. Patients for whom ethics consultation was requested were typically male (55.8 %), white (57.1 %), between 50 and 69 years old (38.5 %), of non-Hispanic origin (85.9 %), and of Roman Catholic faith (43.6 %). Nearly half (47.4 %) were in the intensive care unit and 44.2 % died in the hospital. The most frequent broad ethical categories were decision-making (93.6 %), goals of care/treatment (80.8 %), and end-of-life (73.1 %). More specifically, capacity (57.1 %), patient's wishes/autonomy (54.5 %), and surrogate decision maker (51.3 %) were the most frequent particular ethical issues. The most common key ethical issues were withdrawing/withholding treatment (12.8 %), patient wishes/autonomy (12.2 %), and capacity (11.5 %). Our findings provide additional data to inform the training of clinical ethics consultants regarding the ethical issues that arise in practice. A wider research agenda should be formed to collect and compare data across institutions to improve education and training in our field.

  2. What should be given a priority – costly medications for relatively few people or inexpensive ones for many? The Health Parliament public consultation initiative in Israel

    Science.gov (United States)

    Guttman, Nurit; Shalev, Carmel; Kaplan, Giora; Abulafia, Ahuva; Bin‐Nun, Gabi; Goffer, Ronen; Ben‐Moshe, Roei; Tal, Orna; Shani, Mordechai; Lev, Boaz

    2008-01-01

    Abstract Background  In the past two decades, government and civic organizations have been implementing a wide range of deliberative public consultations on health care‐related policy. Drawing on these experiences, a public consultation initiative in Israel called the Health Parliament was established. Goals  To implement a public consultation initiative that will engage members of the public in the discussion of four healthcare policy questions associated with equity in health services and on priorities for determining which medications and treatments should be included in the basket of national health services. Method  One hundred thirty‐two participants from the general population recruited through a random sample were provided with background materials and met over several months in six regional sites. Dilemma activities were used and consultants were available for questions and clarifications. Participants presented their recommendations in a national assembly to the Minister of Health. Outcomes  Across the regional groups the recommendations were mostly compatible, in particular regarding considering the healthcare system’s monetary state, even at the expense of equity, but for each policy question minority views were also expressed. A strong emphasis in the recommendations was pragmatism. Conclusion  Participants felt the experience was worthwhile; though the actual impact of their recommendations on policy making was indirect, they were willing to participate in future consultations. However, despite enthusiasm the initiative was not continued. Issues raised are whether consultation initiatives must have a direct impact on healthcare policy decisions or can be mainly a venue to involve citizens in the deliberation of healthcare policy issues. PMID:18429997

  3. Absence of routine medical consultation among hypertensive and/or diabetic elders: an epidemiological study based on the Brazilian National Household Survey 2008

    Directory of Open Access Journals (Sweden)

    Daniela Nice Ferreira

    2015-09-01

    Full Text Available OBJECTIVE: This exploratory study aimed to investigate the predisposing, enabling and health need characteristics associated with lack of medical visits in the last 12 months, among 23,620 elderly hypertensive and/or diabetic individuals.METHODS: In this research, we used the theoretical behavioral model of Andersen and Newman for use of health services. The data analyzed were produced by the health supplement of the Brazilian National Household Survey (PNAD 2008, nationwide. To identify the associations, we used the Poisson regression model, which estimates the prevalence ratios and confidence intervals of 95%, considering the significance level of 5%.RESULTS: The results showed that 10.6% of the study population did not consult the doctor in the period considered, and the prevalence was higher among hypertensive subjects (10.5% than among diabetic ones (7.1%. The lack of medical consultation was negatively associated with female sex and increasing age (predisposing characteristics, with health insurance coverage (enabling characteristic, worse self-rated health, chronic health conditions selected and the presence of hypertension associated with diabetes (health needs, while the fact of living in the Northeast, North and Midwest appeared positively associated with the event under investigation.CONCLUSION: These results corroborate those observed in national and international studies and show evidence of inequality and inequity in the use of medical consultation for this population, based on the findings related to health plan coverage and geographic region.

  4. Can we rely on simulated patients' satisfaction with their consultation for assessing medical students' communication skills? A cross-sectional study.

    Science.gov (United States)

    Gude, T; Grimstad, H; Holen, A; Anvik, T; Baerheim, A; Fasmer, O B; Hjortdahl, P; Vaglum, P

    2015-12-18

    In medical education, teaching methods offering intensive practice without high utilization of faculty resources are needed. We investigated whether simulated patients' (SPs') satisfaction with a consultation could predict professional observers' assessment of young doctors' communication skills. This was a comparative cross-sectional study of 62 videotaped consultations in a general practice setting with young doctors who were finishing their internship. The SPs played a female patient who had observed blood when using the toilet, which had prompted a fear of cancer. Immediately afterwards, the SP rated her level of satisfaction with the consultation, and the scores were dichotomized into satisfaction or dissatisfaction. Professional observers viewed the videotapes and assessed the doctors' communication skills using the Arizona Communication Interview Rating Scale (ACIR). Their ratings of communication skills were dichotomized into acceptable versus unacceptable levels of competence. The SPs' satisfaction showed a predictive power of 0.74 for the observers' assessment of the young doctors and whether they reached an acceptable level of communication skills. The SPs' dissatisfaction had a predictive power of 0.71 for the observers' assessment of an unacceptable communication level. The two assessment methods differed in 26% of the consultations. When SPs felt relief about their cancer concern after the consultation, they assessed the doctors' skills as satisfactory independent of the observers' assessment. Accordance between the dichotomized SPs' satisfaction score and communication skills assessed by observers (using the ACIR) was in the acceptable range. These findings suggest that SPs' satisfaction scores may provide a reliable source for assessing communication skills in educational programs for medical trainees (students and young doctors). Awareness of the patient's concerns seems to be of vital importance to patient satisfaction.

  5. An Opportunity to achieve the 5th Millennium Development Goal in Kenya using E-Medical Consultation in the Diagnosis and Treatment of Hypertension in Pregnancy

    Directory of Open Access Journals (Sweden)

    J.Gudu

    2013-01-01

    Full Text Available This study sought to establish the challenges that the Reproductive Health Division (High Risk Pregnancy Clinic at Moi Teaching and Referral Hospital based in Eldoret town, one of the two referral hospitals in Kenya, faces in achieving the 5th Millennium Development Goal and adopting e-medical consultation as a way of improving maternal healthcare for patients with Hypertension in Pregnancy and reducing maternal deaths. The study was carried out using hybrid of qualitative and quantitative research methodology In this paper, an outline of the strategies and pillars that the Clinic needs to adopt to embrace the use of e-medical consultation for the diagnosis, treatment and management of Hypertension in Pregnancy is presented. The survey conducted established that the division is still lagging behind and has not adopted the use of e-Health, especially in the consultation sessions between the doctors and patients. The outlined strategies when implemented will help steer the Reproductive Health Division (High Risk Pregnancy Clinic towards making healthcare services available in an efficient and effective way to expectant women with the condition. The model could be adopted to extend the same to less endowed areas around the globe, where specialist: patient ratio is low.

  6. Are psychophysiological arousal and self-reported emotional stress during an oncological consultation related to memory of medical information? An experimental study.

    Science.gov (United States)

    Visser, Leonie N C; Tollenaar, Marieke S; Bosch, Jos A; van Doornen, Lorenz J P; de Haes, Hanneke C J M; Smets, Ellen M A

    2017-01-01

    Patients forget 20-80% of information provided during medical consultations. The emotional stress often experienced by patients during consultations could be one of the mechanisms that lead to limited recall. The current experimental study therefore investigated the associations between (analog) patients' psychophysiological arousal, self-reported emotional stress and their (long term) memory of information provided by the physician. One hundred and eighty one cancer-naïve individuals acted as so-called analog patients (APs), i.e. they were instructed to watch a scripted video-recoding of an oncological bad news consultation while imagining themselves being in the patient's situation. Electrodermal and cardiovascular activity (e.g. skin conductance level and heart rate) were recorded during watching. Self-reported emotional stress was assessed before and after watching, using the STAI-State and seven Visual Analog Scales. Memory, both free recall and recognition, was assessed after 24-28 h. Watching the consultation evoked significant psychophysiological and self-reported stress responses. However, investigating the associations between 24 psychophysiological arousal measures, eight self-reported stress measures and free recall and recognition of information resulted in one significant, small (partial) correlation (r = 0.19). Considering multiple testing, this significant result was probably due to chance. Alternative analytical methods yielded identical results, strengthening our conclusion that no evidence was found for relationships between variables of interest. These null-findings are highly relevant, as they may be considered to refute the long-standing, but yet untested assumption that a relationship between stress and memory exists within this context. Moreover, these findings suggest that lowering patients' stress levels during the consultation would probably not be sufficient to raise memory of information to an optimal level. Alternative

  7. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

    Science.gov (United States)

    Zhao, Chengquan; Wu, Tao; Ding, Xiangdong; Parwani, Anil V.; Chen, Hualin; McHugh, Jeffrey; Piccoli, Anthony; Xie, Qinling; Lauro, Gonzalo Romero; Feng, Xiaodong; Hartman, Douglas J.; Seethala, Raja R.; Wu, Shangwei; Yousem, Samuel; Liang, Yaoming; Pantanowitz, Liron

    2015-01-01

    Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated

  8. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

    Directory of Open Access Journals (Sweden)

    Chengquan Zhao

    2015-01-01

    Full Text Available Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4% submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%, followed by bone/soft tissue (21.0% and gynecologic/breast (20.2% subspecialties. Average turnaround time (TAT per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7% where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and

  9. Sharing Expertise: Consulting

    Science.gov (United States)

    Graves, Bill

    2011-01-01

    A special breed of superintendents who have developed expertise in a particular area find ways of sharing it in other venues as outside consultants. They pull extra duty to put their special skills into practice, to give back to their communities, to stay current and grounded in the field, or to enhance their professional reputations. They teach…

  10. Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson's disease

    NARCIS (Netherlands)

    Lakshminarayana, R.; Wang, D.; Burn, D.; Chaudhuri, K.R.; Galtrey, C.; Guzman, N.V.; Hellman, B.; Ben, J.; Pal, S.; Stamford, J.; Steiger, M.; Stott, R.W.; Teo, J.; Barker, R.A.; Wang, E.; Bloem, B.R.; Eijk, M. van; Rochester, L.; Williams, A.

    2017-01-01

    The progressive nature of Parkinson's disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with Parkinson's disease patients, making it difficult to

  11. Ground truth delineation for medical image segmentation based on Local Consistency and Distribution Map analysis.

    Science.gov (United States)

    Cheng, Irene; Sun, Xinyao; Alsufyani, Noura; Xiong, Zhihui; Major, Paul; Basu, Anup

    2015-01-01

    Computer-aided detection (CAD) systems are being increasingly deployed for medical applications in recent years with the goal to speed up tedious tasks and improve precision. Among others, segmentation is an important component in CAD systems as a preprocessing step to help recognize patterns in medical images. In order to assess the accuracy of a CAD segmentation algorithm, comparison with ground truth data is necessary. To-date, ground truth delineation relies mainly on contours that are either manually defined by clinical experts or automatically generated by software. In this paper, we propose a systematic ground truth delineation method based on a Local Consistency Set Analysis approach, which can be used to establish an accurate ground truth representation, or if ground truth is available, to assess the accuracy of a CAD generated segmentation algorithm. We validate our computational model using medical data. Experimental results demonstrate the robustness of our approach. In contrast to current methods, our model also provides consistency information at distributed boundary pixel level, and thus is invariant to global compensation error.

  12. Situational Consultation

    Science.gov (United States)

    Rimehaug, Tormod; Helmersberg, Ingunn

    2010-01-01

    Situational Consultation (SC) is presented as a framework for flexible integration of several models and methodologies in consultation practice by choosing an approach adapted to the specific situation. In SC, models and their characteristic role positions are considered interchangeable tools with qualitative differences in strengths and…

  13. An explanatory randomised controlled trial of a nurse-led, consultation-based intervention to support patients with adherence to taking glucose lowering medication for type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Farmer Andrew

    2012-04-01

    Full Text Available Abstract Background Failure to take medication reduces the effectiveness of treatment leading to increased morbidity and mortality. We evaluated the efficacy of a consultation-based intervention to support objectively-assessed adherence to oral glucose lowering medication (OGLM compared to usual care among people with type 2 diabetes. Methods This was a parallel group randomised trial in adult patients with type 2 diabetes and HbA1c≥7.5% (58 mmol/mol, prescribed at least one OGLM. Participants were allocated to a clinic nurse delivered, innovative consultation-based intervention to strengthen patient motivation to take OGLM regularly and support medicine taking through action-plans, or to usual care. The primary outcome was the percentage of days on which the prescribed dose of medication was taken, measured objectively over 12 weeks with an electronic medication-monitoring device (TrackCap, Aardex, Switzerland. The primary analysis was intention-to-treat. Results 211 patients were randomised between July 1, 2006 and November 30, 2008 in 13 British general practices (primary care clinics. Primary outcome data were available for 194 participants (91.9%. Mean (sd percentage of adherent days was 77.4% (26.3 in the intervention group and 69.0% (30.8 in standard care (mean difference between groups 8.4%, 95% confidence interval 0.2% to 16.7%, p = 0.044. There was no significant adverse impact on functional status or treatment satisfaction. Conclusions This well-specified, theory based intervention delivered in a single session of 30 min in primary care increased objectively measured medication adherence, with no adverse effect on treatment satisfaction. These findings justify a definitive trial of this approach to improving medication adherence over a longer period of time, with clinical and cost-effectiveness outcomes to inform clinical practice. Trial registration Current Controlled Trials ISRCTN30522359

  14. Professional DOC (PDOC): a software environment for authoring and consulting of electronic documentation. INTERACTIVE DIAGNOSIS and THERAPY: a medical application.

    OpenAIRE

    Abbolito, A.; Camici, A.; Spampinato, A.

    1992-01-01

    Professional DOC (PDOC) is a software environment for electronic documentation authoring and consulting based on the Hypermedia technology. It allows to manage different kinds of information (pictures, sounds, texts, graphics, video) organized according to hyperstructures. The user-friendliness and effectiveness of its man-machine interface, and its availability on the most common hardware platforms makes it a suitable product for a very broad category of users. INTERACTIVE DIAGNOSIS AND THER...

  15. iConnect CKD - Virtual Medical Consulting: a web-based Chronic Kidney Disease, Hypertension and Diabetes Integrated Care Program.

    Science.gov (United States)

    Katz, Ivor J; Pirabhahar, Saiyini; Williamson, Paula; Raghunath, Vishwas; Brennan, Frank; O'Sullivan, Anthony; Youssef, George; Lane, Cathie; Jacobson, Gary; Feldman, Peter; Kelly, John

    2017-05-04

    Chronic kidney disease (CKD) patients overwhelm specialist services and can potentially be managed in the primary care (PC). Opportunistic screening of high risk (HR) patients and follow-up in PC is the most sustainable model of care. A 'virtual consultation' (VC) model instead of traditional face to face (F2F) consultations was used, aiming to assess efficacy and safety of the model. Seventy patients were recruited from PC sites and hospital clinics, and followed for one year. The HR patients (eGFR 30 mg/mmol/L) were randomised to either VC or F2F. Patients were monitored 6 monthly by a Clinical Nurse Specialist (CNS). The specialist team provided virtual or clinical support and included a Nephrologist, Endocrinologist, Cardiologist and Renal 'Palliative' Supportive Care. Sixty one (87%) patients were virtually tracked or consulted with 14 (23%) being HR. At 12 months there was no difference in outcomes between VC and F2F patients. All patients were successfully monitored. GPs reported high level of satisfaction and supported the model, but found software integration challenging. Patients found the system attractive and felt well managed. Specialist consults occurred within a week and if a second specialist opinion was required it took another two weeks. The program demonstrated safe, expedited and efficient follow up with a clinical and web based program. Support from the GPs and patients was encouraging, despite logistical issues. Ongoing evaluation of VC services will continue and feasibility to larger networks and more chronic diseases remains the long term goal. This article is protected by copyright. All rights reserved.

  16. Erectile dysfunction in the community: trends over time in incidence, prevalence, GP consultation and medication use--the Krimpen study: trends in ED.

    Science.gov (United States)

    Schouten, Boris W V; Bohnen, Arthur M; Groeneveld, Frans P M J; Dohle, Gert R; Thomas, Siep; Bosch, J L H Ruud

    2010-07-01

    In the general population, erectile dysfunction (ED) is surrounded by a "taboo." Epidemiologists studying this problem have to be aware of the phenomenon of the "tip-of-the-iceberg." Our aim is to describe the iceberg phenomenon for ED and their help-seeking behavior in the general population during a period when public interest in ED heightened and waned after the introduction of the drug sildenafil. The data were obtained as part of a large longitudinal community-based study, i.e., the Krimpen study. With four rounds of data collection with an approximate 2.1 years interval, the local pharmacists provided data on medication use, whereas abstracts from the medical record and history were provided by the local general practitioners (GPs). The data from the questionnaires were entered into the Krimpen study database but were not communicated to the GPs. ED: according to the ICS-questionnaire, GP consultation: search of electronic medical dossier for ED or reports from any specialist, use of ED medication as delivered by the pharmacy. The age-standardized prevalence of ED is stable, i.e., around 40%. During the period 1995 to 2000, the incidence increased from 5% to 6.5%, then it stabilizes around 5% per year. The first-time use of ED medication increases exponentially between 1995 and 2000, then it stabilizes at about 3.5% per year. The number of GP consultations by men with ED increases up to 1999, after which it stabilizes at about 1.8% per year. We suggest that the availability and awareness of a new pharmacological option induced a change of behavior among GPs and their patients.

  17. 门诊慢性肝病患者药物咨询的回顾性分析%Retrospective Analysis of Medication Consultation for Outpatients with Chronic Liver Disease

    Institute of Scientific and Technical Information of China (English)

    吴荣荣; 刘峰群; 韩晋; 陈红鸽; 魏振满

    2012-01-01

    目的 分析慢性肝病患者门诊药物咨询情况,总结工作经验,以提高合理用药的水平.方法 对2011年583例慢性肝病患者的药物咨询情况,按咨询者年龄、性别、咨询内容、咨询药物品种进行分类统计.结果 咨询者以中年患者居多,占68.27%,且男性多于女性.咨询内容中一般性问题占总咨询数的67.58%,药学专业问题以药物不良反应和药物相互作用为主.结论 开展药物咨询,指导患者合理、安全用药十分重要,是临床药学工作的一项重要内容.%Objective To analyze the medication consultation for outpatients with chronic liver disease and to summarize the work experiences for increasing the level of rational drug use. Methods The situation in 583 cases of medication consultation during 2011 was performed the classification statistic in aspects of ages, genders, consulting contents, consulting contents and consulting drug types. Results Most of the patients asking for consultation, accounting for 68.27% ,were in middle age, and males were more than females. In the consulting contents, the generalized questions accounted for 67. 58% of the total consultations, and the pharmacy professional questions were dominated by the drug interactions and adverse drug reaction (ADR). Conclusion Launching the medication consultation and guiding the patient' s rational and safe medication is very important and an important content of clinical pharmaceutical service.

  18. Perceived incivility during emergency department phone consultations.

    Science.gov (United States)

    Shetty, Amith L; Vaghasiya, Milan; Boddy, Rachel; Byth, Karen; Unwin, Danielle

    2016-06-01

    Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties. Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P  4 (9.1% vs 3.8%, P incivility during ED phone consultations. Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Risk factors for delays between intake and veterinary approval for adoption on medical grounds in shelter puppies and kittens

    OpenAIRE

    Litster, Annette; Allen, Joselyn; Mohamed, Ahmed; He, Shuang

    2011-01-01

    To maximize their capacity to save lives and optimize resource allocation, animal shelters need to identify highly adoptable animals that are unlikely to be delayed on medical grounds before they can be made available for adoption. In this retrospective cohort study, our objective was to identify risk factors for delays from intake to approval for adoption on medical grounds in shelter puppies and kittens. Shelter medical records from 2008 for 335 puppies and 370 kittens were selected randoml...

  20. The transition to hospital consultant

    DEFF Research Database (Denmark)

    Westerman, Michiel; Teunissen, Pim W.; Jorgensen, Rasmus Lundhus

    2013-01-01

    Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic comp...... competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored....

  1. Research on Online Medical Consultation From the Physician's Perspective%基于医生视角的在线医疗咨询调查研究

    Institute of Scientific and Technical Information of China (English)

    徐志杰; 赵优冬; 许炳章; 朱德帅; 李海昕

    2015-01-01

    为了解医生在在线医疗咨询服务平台上的工作情况,分析该服务可能对患者产生的影响,文章在电子问卷平台上完成问卷的制作后以电子链接随机发送给在"春雨医生"上在线健康答疑的医生,收集整理问卷后,根据统计结果评价医生与患者的在线互动情况.回收有效问卷520份.多数在线健康答疑的医生上线答疑频率较高(73.85%),但愿意主动了解患者获取在线健康信息情况并提供指导的比例相对较低.文章得出结论:医生提供在线医疗咨询服务的质量良莠不齐,因而对患者的帮助程度相差也很大.建议医生线上答疑时应遵守问诊规范,线下诊疗时主动了解患者获取的在线健康信息的情况,并耐心仔细地提供指导.%In order to know the status of the online medical consultation the physicians provide on the Internet, and analyze the possible influence on the patients,after finishing making the E-questionnaire on the web,spread it by hyperlink to research the physicians on the app"Chun-yu doctor"randomly,gather and neaten the E-questionnaires, elevating the quality of the interaction online between physicians and patients then.The effective questionnaires sum into 520.More than a half consult for the patients online frequently(73.85%).But fewer physicians tend to know what the patients know from the Internet or give them guidance.The paper draws conclusion that the quality of the service of the online medical consultation varies,which help the patients in different degree.We suggest that the physicians keep the regulations when consulting online,and ask for what the patients know from the Internet,giving them guidance patiently and carefully.

  2. 257例儿童药物咨询回顾性分析%Retrospective Analysis of 257 Cases of Children's Medication Consultation

    Institute of Scientific and Technical Information of China (English)

    杨智; 张海霞; 蒋志平; 何周康

    2014-01-01

    Objective To review the children's medicine consultation work for further promotion of drug consultation service and improvementof the quality of pharmaceutical care for children in our hospital. Methods The records of medicine consultation service were collected during January, 2010 to December, 2012 and the the inquisitor's identity, the classification of drugs and advisory content were retrospectively analysed. Results The identities of inquisitors were mainly children's parents. The others were medical staff and pharmacist/medical technologists. Antibiotic agents are the most frequently counseled and secondly the clinical common drugs and digestive agents. The contents of consultation are mainly about usage and dosage of drugs (48.16%), then the adverse reactions and cautions(14.72%), indications(11.37%), drug interaction and incompatibility ( 8 . 03%) . Conclusion Medication consultation plays an important role in the pediatric pharmaceutical service. This work could be an important way to improve the safety and rationality of children's drug use, and can increase the drug use compliance and ensure safety and effectiveness of pediatric medication.%目的:了解我省儿童医院药物咨询工作情况,提高药物咨询服务的质量。方法收集本院2010年1月~2012年12月257例儿科相关药物咨询记录,对咨询者身份、咨询药物类别及咨询内容进行回顾性分析。结果咨询者以患儿家属为主(91.83%),其次为医生、护士、药师和其他医务人员;咨询药物以抗感染药物最多(19.23%),其次为临床各科专用药物和消化系统用药;咨询内容以药品用法用量为主(48.16%),其次为药品不良反应和用药注意事项(14.72%)、药品适应证(11.37%)、药物相互作用和配伍禁忌(8.03%)。结论药物咨询是儿科药学服务的重要内容,是提高儿童用药安全性和合理性的重要途径;提高药物咨询服务水平,有利于提

  3. Ischemic Heart Disease and Work Disability in Patients Treated at the Internal Medicine Consultation and Assessed by the Expert Medical Labor Commission

    Directory of Open Access Journals (Sweden)

    Belkis Vicente Sánchez

    2016-02-01

    Full Text Available Background: ischemic heart disease represents a major challenge given the large number of people affected by this condition, its increasing contribution to overall mortality, the frequent disability resulting from it, and the complexity and high cost of its treatment. Objective: to describe the work disability caused by ischemic heart disease in patients treated at the internal medicine consultation and assessed by the Expert Medical Labor Commission of Cienfuegos municipality. Methods: a cross-sectional study was conducted including all patients with ischemic heart disease treated at the internal medicine consultation and assessed by the Expert Medical Labor Commission of Cienfuegos municipality from October 2012 to July 2013. The variables analyzed were: age, sex, occupation, years of work and accrued salary, clinical diagnosis, length of time the condition had been present and associated chronic diseases; existence of prior assessment by an Expert Medical Labor Commission and decision reached, previous days of sick leave and current decision of the commission. The data were analyzed using SPSS (version 18.0 and the results are shown in tables and graphs as numbers and percentages. Results: a predominance of men was observed. Forty two point nine percent were service workers and the average number of years of work was 24.60. Forty two point nine percent were previously assessed by the commission. Two hundred one point thirteen days of sick leave were granted and social security expenditure in a month was high. Diabetes mellitus was the most common chronic disease followed by hypertension, obesity and dyslipidemia. Of the workers previously assessed, half received permanent and temporary disability benefits. Conclusions: ischemic heart disease causes different degrees of disability. Its costs in terms of social security are increasing.

  4. Complementary medicines in medicine: Conceptualising terminology among Australian medical students using a constructivist grounded theory approach.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2015-02-01

    Terminology around the use of complementary medicines (CM) within medical discourse is ambiguous. Clear collective discourse within the medical context is required. This study reports the findings of a Constructivist Grounded Theory Method study used to explore medical students' conceptualisation of terminology and associated value components around CMs as evidenced within their discourse community. The results show that terminology surrounding CMs within medicine is politically charged and fraught with value judgements. Terms used to describe CMs were considered, many of which were deemed problematic. Categorisation of specific medicines was also deemed inappropriate in certain contexts. Conceptualisation of CM terminology, categorisation and value implications, discriminated between levels of evidence for CMs and provided insights into the social change of medicine towards emergence of an evidence-based integrative approach. The results show that terminology surrounding CM is a social construct consistent with fluid conceptualisation and operationalisation in different social contexts.

  5. Coping with illness and threat: why non-religious Jews choose to consult rabbis on healthcare issues.

    Science.gov (United States)

    Keshet, Yael; Liberman, Ido

    2014-08-01

    Whereas modern and advanced medical services are available and accessible to all citizens of Israel, the phenomenon of consulting Orthodox rabbis (Jewish clerics) on healthcare issues is gaining ground among populations that do not identify themselves as religious. The objective of the research was to enquire why non-religious Jews choose to consult rabbis on medical issues. Fifty semi-structured open-ended interviews were conducted during 2009-2011 in northern Israel. The article presents the respondents' main motives, expectations, beliefs, and modes of consulting both physicians and rabbis. This study aims to contribute to discussion about conflating modern medicine with spiritual-religious beliefs in modern-secular society.

  6. Factors that influence cancer patients' and relatives' anxiety following a three-person medical consultation: impact of a communication skills training program for physicians.

    Science.gov (United States)

    Lienard, Aurore; Merckaert, Isabelle; Libert, Yves; Delvaux, Nicole; Marchal, Serge; Boniver, Jacques; Etienne, Anne-Marie; Klastersky, Jean; Reynaert, Christine; Scalliet, Pierre; Slachmuylder, Jean-Louis; Razavi, Darius

    2008-05-01

    No study has yet assessed the impact of physicians' skills acquisition after a communication skills training program on changes in patients' and relatives' anxiety following a three-person medical consultation. This study aimed at comparing, in a randomized study, the impact, on patients' and relatives' anxiety, of a basic communication skills training program and the same program consolidated by consolidation workshops and at investigating physicians' communication variables associated with patients' and relatives' anxiety. Consultations with a cancer patient and a relative were recorded and analyzed by the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' anxiety were assessed with the State-Trait Anxiety Inventory-State. No statistically significant change over time and between groups was observed. Mixed-effects modeling of changes in patients' and relatives' anxiety showed that decreases in both patients' and relatives' anxiety were linked with patients' and relatives' self-reported distress (p = 0.031 and 0.005), and that increases in both patients' and relatives' anxiety were linked with physicians' breaking bad news (p = 0.028 and 0.005). No impact of the training program was observed. Results indicate the need to further study communication skills which may help reduce patients' and relatives' anxiety especially when breaking bad news.

  7. Educational climate seems unrelated to leadership skills of clinical consultants responsible of postgraduate medical education in clinical departments

    DEFF Research Database (Denmark)

    Malling, Bente Vigh; Mortensen, Lene S.; Scherpbier, Albert J J;

    2010-01-01

    The educational climate is crucial in postgraduate medical education. Although leaders are in the position to influence the educational climate, the relationship between leadership skills and educational climate is unknown. This study investigates the relationship between the educational climate...

  8. Observed Consultation: Confidence and Accuracy of Assessors

    Science.gov (United States)

    Tweed, Mike; Ingham, Christopher

    2010-01-01

    Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items; attributes of consultation; a…

  9. Observed Consultation: Confidence and Accuracy of Assessors

    Science.gov (United States)

    Tweed, Mike; Ingham, Christopher

    2010-01-01

    Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items; attributes of consultation; a…

  10. Non-doctor consultations and self-medication practices in patients seen at a tertiary dental center in Ibadan

    Directory of Open Access Journals (Sweden)

    Happy Adeyinka Adedapo

    2011-01-01

    Conclusion: Self-medication practices were quite high in this study, and these practices were also prevalent among the educated people. Drug control enforcement needs to be intensified and dental public health education needs to be given greater priority in the overall public health campaigns.

  11. Emergency Medical Technicians Are Often Consulted on Termination of Resuscitation, and Will Terminate Resuscitation Based on Controversial Single Factors

    DEFF Research Database (Denmark)

    Mygind-Klausen, Troels; Glerup Lauridsen, Kasper; Bødtker, Henrik

    2016-01-01

    Introduction: Many out-of-hospital cardiopulmonary resuscitation (CPR) attempts have to be terminated. Previous studies have investigated knowledge on abandoning resuscitation among physicians. In the prehospital setting emergency medical technicians (EMTs) may be involved in the decision...... on abandoning CPR but this is sparsely investigated. Aim: To investigate if EMTs are involved in termination of CPR, their self-assessed competence and knowledge of guidelines on termination of CPR according to European Resuscitation Council guidelines 2015. In addition, to evaluate single factors...... that according to an EMT should lead to termination of CPR. Methods: This was a pilot-study including EMTs from a Danish Emergency Medical Service. Data was collected using a structured questionnaire. All responses were collected anonymously. Results: In total, 50 EMTs (male: 88%, median age: 38, response rate...

  12. Chronic Abdominal Pain in Children and Adolescents: Parental Threat Perception Plays a Major Role in Seeking Medical Consultations.

    Science.gov (United States)

    Calvano, Claudia; Warschburger, Petra

    2016-01-01

    Background. Pain symptoms, associated impairment, and parental perception of threat are reported to be predictors of health care utilization (HCU) in childhood chronic abdominal pain (CAP). However, mediating variables and their interrelations have not yet been systematically studied. Objectives. This study aims to identify mediating pathways of influence between child's abdominal pain and the number of pain-related medical visits. Methods. In a multicenter study, we recruited N = 151 parent-child dyads with children aged 6-17 years suffering from CAP. A composite measure of pain symptoms was defined as predictor and the number of pain-related medical visits as outcome variable. This relation was analyzed by serial mediation, including child- and parent-reported impairment and parental threat perception as mediators. Results. Only parental threat perception significantly linked child's pain symptoms to the number of medical visits. Measures of impairment did not have a significant effect. Conclusions. Parental pain-related threat perception is strongly related to health care seeking in childhood CAP. Addressing threat perception might be a fruitful parent-centered approach in clinical practice.

  13. How Iranian Medical Trainees Approach their Responsibilities in Clinical Settings; A Grounded Theory Research

    Directory of Open Access Journals (Sweden)

    Omid Asemani

    2015-09-01

    Full Text Available Background: It seems we are now experiencing “responsibility problems” among medical trainees (MTs and some of those recently graduated from medical schools in Iran. Training responsible professionals have always been one of the main concerns of medical educators. Nevertheless, there is a dearth of research in the literature on “responsibility” especially from the medical education point of view. Therefore, the present study was carried out with the aim of presenting a theoretical based framework for understanding how MTs approach their responsibilities in educational settings. Method: This qualitative study was conducted at Shiraz University of Medical Sciences (SUMS using the grounded theory methodology. 15 MTs and 10 clinical experts and professional nurses were purposefully chosen as participants. Data was analyzed using the methodology suggested by Corbin and Strauss, 1998. Results: “Try to find acceptance toward expectations”, “try to be committed to meet the expectations” and “try to cope with unacceptable expectations” were three main categories extracted based on the research data. Abstractly, the main objective for using these processes was “to preserve the integrity of student identity” which was the core category of this research too. Moreover, it was also found that practically, “responsibility” is considerably influenced by lots of positive and negative contextual and intervening conditions. Conclusion: “Acceptance” was the most decisive variable highly effective in MTs’ responsibility. Therefore, investigating the “process of acceptance” regarding the involved contextual and intervening conditions might help medical educators correctly identify and effectively control negative factors and reinforce the constructive ones that affect the concept of responsibility in MTs.

  14. Online medical literature consultation habits of academic teaching physicians in the EU and CIS countries: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Chiel T M van der Voort

    Full Text Available BACKGROUND: Both in the Commonwealth of Independent States (CIS and in the European Union (EU2004, ample availability of up to date medical scientific literature is important for progress in medical science and for the education of the next generation of healthcare workers. The aim of this research is to assess if the use of online medical literature among academic teaching (AT physicians is at the same level in the CIS as in the EU2004. METHODOLOGY/PRINCIPAL FINDINGS: In the capital cities of the CIS and the EU2004 member states, AT physicians holding an academic position at least equivalent to an associate professor and performing the three classical tasks in academic medicine (teaching, research and patient care were interviewed about their use of and familiarity with the Internet and 9 online literature services, including journals and bibliographical databases such as PubMed (Medline, The Cochrane Library and Web of Science. Library staff members were interviewed about the availability of these online literature services at their libraries. About 750 physicians and 40 library staff members were invited for participation. Eventually 124 AT physicians and 22 library staff members participated. Internet was everywhere available, but used daily by more AT physicians in the EU2004 (71% versus 48% in the CIS, P = .005. AT physicians in the EU2004 accessed a higher percentage of all articles online (74% versus 43% in the CIS, P<.001. PubMed (P<.001, The Cochrane Library (P<.001 and Web of Science (P<.003 were used more frequently in the EU2004. In the EU2004 more AT physicians were familiar with Open Access journals (89% versus 51% in the CIS, P<.001. CONCLUSIONS/SIGNIFICANCE: AT physicians in the CIS use online medical literature less than in the EU2004. It is recommended that the awareness of freely available online literature services such as Open Access journals is enhanced among AT physicians and library staff members, especially in the

  15. Impact of adding additional providers to resident workload and the resident experience on a medical consultation rotation.

    Science.gov (United States)

    Fang, Michele; Linson, Eric; Suneja, Manish; Kuperman, Ethan F

    2017-02-22

    Excellence in Graduate Medical Education requires the right clinical environment with an appropriate workload where residents have enough patients to gain proficiency in medicine with optimal time for reflection. The Accreditation Council for Graduate Medical Education (ACGME) has focused more on work hours rather than workload; however, high resident workload has been associated with lower resident participation in education and fatigue-related errors. Recognizing the potential risks associated with high resident workload and being mindful of the costs of reducing resident workload, we sought to reduce residents' workload by adding an advanced practice provider (APP) to the surgical comanagement service (SCM) and study its effect on resident satisfaction and perceived educational value of the rotation. In Fiscal Year (FY) 2014 and 2015, an additional faculty member was added to the SCM rotation. In FY 2014, the faculty member was a staff physician, and in FY 2015, the faculty member was an APP.. Resident workload was assessed using billing data. We measured residents' perceptions of the rotation using an anonymous electronic survey tool. We compared FY2014-2015 data to the baseline FY2013. The number of patients seen per resident per day decreased from 8.0(SD 3.3) in FY2013 to 5.0(SD 1.9) in FY2014 (p rotation (40.0%, 72.2%, 72.6% in FY2013, 2014, 2015 respectively, p rotation.

  16. How to make the medical consultation more successful from a patient's perspective? Tips for doctors and patients from lay people in the United Kingdom, Italy, Belgium and the Netherlands.

    NARCIS (Netherlands)

    Bensing, J.M.; Deveugele, M.; Moretti, F.; Fletcher, I.; Vliet, L. van; Bogaert, M. van; Rimondini, M.

    2011-01-01

    Objective: The aim of this study is to generate empirically based 'tips' from lay people on how medical consultations could become more successful from a patient perspective. Methods: 258 Lay people in the United Kingdom, Italy, Belgium and the Netherlands, distributed over 32 focus groups, were inv

  17. Individual Consultations

    Directory of Open Access Journals (Sweden)

    Ian Walkinshaw

    2015-09-01

    Full Text Available Responding to calls for research into measurable English language outcomes from individual language support consultations at universities, this study investigated the effect of individual consultations (ICs on the academic writing skills and lexico-grammatical competence of students who speak English as an additional language (EAL. Attendance by 31 EAL students at ICs was recorded, and samples of their academic writing texts before and after a 9-month interval were compared. Participants’ academic writing skills were rated, and lexico-grammatical irregularities were quantified. No statistically significant positive shifts manifested, due to the relatively short research period and limited participant uptake, but there were encouraging predictors of future shifts given continued utilization of the service. First, although a Wilcoxon signed-rank test showed no association between attendance at ICs and shifts in academic writing ability, a Spearman’s rho calculation suggested a tentative relationship to positive pre–post shifts in three academic writing sub-skills: Task Fulfillment, Grammar, and Vocabulary. Second, instances of four common lexico-grammatical irregularities (subject/verb, wrong word, plural/singular, and punctuation declined at post-testing. Although only regular, sustained attendance would produce statistically significant shifts, there is a potential association between participants’ use of ICs and improved academic writing skills/lexico-grammatical competence.

  18. The RAFT network: 5 years of distance continuing medical education and tele-consultations over the Internet in French-speaking Africa.

    Science.gov (United States)

    Geissbuhler, Antoine; Bagayoko, Cheick Oumar; Ly, Ousmane

    2007-01-01

    Continuing education of healthcare professionals is a key element for the quality and efficiency of a health system. In developing countries, this activity is usually limited to capitals, and delocalized professionals do not have access to such opportunities, or to didactic material adapted to their needs. This limits the interest of such professionals to remain active in the periphery, where they are most needed to implement effective strategies for prevention and first-line healthcare. Telemedicine tools enable the communication and sharing of medical information in electronic form, and thus facilitate access to remote expertise. A physician located far from a reference center can consult its colleagues remotely in order to resolve a difficult case, follow a continuous education course over the Internet, or access medical information from digital libraries or knowledge bases. These same tools can also be used to facilitate exchanges between centers of medical expertise: health institutions of a same country as well as across borders. Since 2000, the Geneva University Hospitals have been involved in coordinating the development of a network for eHealth in Africa (the RAFT, Réseau en Afrique Francophone pour la Télémédecine), first in Mali, and now extending to 10 French-speaking African countries. The core activity of the RAFT is the webcasting of interactive courses. These sessions put the emphasis on knowledge sharing across care professionals, usually in the form of presentations and dialogs between experts in different countries. The technology used for the webcasting works with a slow (25 kbits/s) internet connection. Other activities of the RAFT network include visioconferences, teleconsultations based on the iPath system, collaborative knowledge bases development, support for medical laboratories quality control, and the evaluation of the use of telemedicine in rural areas (via satellite connections) in the context of multisectorial development. Finally

  19. Risk factors for delays between intake and veterinary approval for adoption on medical grounds in shelter puppies and kittens.

    Science.gov (United States)

    Litster, Annette; Allen, Joselyn; Mohamed, Ahmed; He, Shuang

    2011-08-01

    To maximize their capacity to save lives and optimize resource allocation, animal shelters need to identify highly adoptable animals that are unlikely to be delayed on medical grounds before they can be made available for adoption. In this retrospective cohort study, our objective was to identify risk factors for delays from intake to approval for adoption on medical grounds in shelter puppies and kittens. Shelter medical records from 2008 for 335 puppies and 370 kittens were selected randomly at a large metropolitan adoption-guarantee shelter. Data including signalment, source shelter, intake veterinary examination findings, clinical history and days from intake until approval by a veterinarian for adoption on medical grounds were extracted from shelter records and analyzed using multivariate Cox regression. Puppies and kittens with clinical signs of respiratory or gastrointestinal disease at intake took significantly longer to receive approval for adoption on medical grounds (puppies - respiratory pkittens - respiratory pkittens were more likely to be delayed than owner-relinquished kittens or those transferred from other shelters (pkittens were less likely to be delayed (pkittens with respiratory and/or ocular signs within 24h of intake significantly reduced time to approval on medical grounds for adoption (puppies p=0.02; kittens p=0.03). The analyses suggested that puppies and kittens with respiratory or gastrointestinal signs on intake are more likely to experience delays between intake and veterinary approval for adoption on medical grounds. Prompt antimicrobial treatment of animals with respiratory and/or ocular signs may decrease length of stay in the shelter.

  20. Medical consultation and communication with a family doctor from the patients’ perspective – a review of the literature

    Directory of Open Access Journals (Sweden)

    Ludmiła Marcinowicz

    2016-09-01

    Full Text Available The modern understanding of the quality of healthcare takes into account new roles that were granted to patients, including the possibility to assess healthcare based on their experience. A review of the literature shows that among the basic dimensions which serve to measure patients’ satisfaction, issues related to communication are essential. The aim of the study is to determine the aspects of communication with a family doctor which are particularly important from the perspective of the patient. A review of the literature from the years 2000–2016 on communication with family doctors was performed, including articles based on both quantitative and qualitative studies. The main source of the data was the English-language online database PubMed, in which articles were searched for based on such key words as: “medical consultation”, “family doctor”, “general practitioner”, “communication”, “patient’s perspective”. Furthermore, information was searched for in Polish-language journals, books and textbooks for physicians, using a method of manual screening. Analysis of the literature allowed for the identification of the following aspects of communicating with a family doctor perceived by patients: the experience of patients, establishing rapport with a patient, listening, informing a patient, non-verbal behavior, use of a computer during a visit, communication issues from older patients’ perspective, and the relationship between communication and dissatisfaction with care. In summary, the problems of communication between the patient and a family doctor are complex and diverse. The patients’ perspective, with regard to expectations and satisfaction with various aspects of care, including communication, is an important indicator of the quality of care delivered by a family physician.

  1. Longer-term impact of cardiology e-consults.

    Science.gov (United States)

    Wasfy, Jason H; Rao, Sandhya K; Kalwani, Neil; Chittle, Melissa D; Richardson, Calvin A; Gallen, Kathleen M; Isselbacher, Eric M; Kimball, Alexandra B; Ferris, Timothy G

    2016-03-01

    Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P cardiology visit during the follow-up period. E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. 军队医院新版电子病历系统对远程会诊的促进%Promotion to Tele-consultation by New Electronic Medical Record System in Military Hospital

    Institute of Scientific and Technical Information of China (English)

    钱海江

    2012-01-01

    This paper describes the using situation and existing problems of tele-consultation system, briefly analyses the support and promotion of the new eletronic medical record system(EMR), which is carrying out in the army, to tele-consultation and discusses the conditions and requirements of ingerconnection between tele-consultation system and EMR.%本文描述了远程会诊系统的使用现状和存在的问题,简要分析了目前正在全军推广的新版电子病历(EMR)系统对远程会诊的支持与促进,并讨论了远程会诊系统与EMR系统相互对接互联的条件和要求.

  3. An internet-based referral/consultation system for the U.S.-associated Pacific Islands: its contribution to orthopedic graduate medical education at Tripler Army Medical Center.

    Science.gov (United States)

    Hensel, Kurt S; Person, Donald A; Schaefer, Richard A; Burkhalter, William E

    2005-03-01

    To evaluate the benefit of the Pacific Island Health Care Project (PIHCP) to our orthopedic graduate medical education program, we performed a retrospective review of our 8-year operative experience with patients referred through this program. Between July 1994 and June 2002, 69 patients underwent 79 orthopedic operative procedures. Patients were categorized by primary diagnosis, anatomic site involved, and surgical treatment rendered. Because many of the patients referred from the PIHCP with tumors were noted to have either unusually large lesions or advanced-stage disease, further analyses of tumor stage and pathologic grade were made. Seven of the 14 oncologic cases surgically treated in our department in the past 8 years were referrals from the PIHCP. Unique operative procedures performed for these tumor patients included one forequarter amputation, one hip disarticulation, one hemipelvectomy, two partial scapulectomies, and one distal ulna excision. We conclude that the PIHCP referrals provide an important and relatively unique contribution to the clinical and operative experience of our orthopedic residents. These patients from the Pacific basin also enhance our orthopedic graduate medical education program by exposing our residents to the special socioeconomic and cultural issues related to caring for people from developing insular countries.

  4. Task analysis of patients' medication-taking practice and the role of making sense: a grounded theory study.

    Science.gov (United States)

    Bajcar, Jana

    2006-03-01

    Patients on long-term medications have varied medication-taking practices and complex and often unmet medication information needs. The objective of this qualitative study was to describe from the patient's perspective the medication-taking tasks performed by patients currently receiving long-term medications and then to hypothesize how these tasks relate to patients' medication information needs. In-depth semistructured interviews were conducted with individuals between the ages of 18 and 65, who had a college or university education, and who were on at least one long-term medication. Grounded theory approach was used for data gathering and data analysis. Maximum variation and theoretical sampling were used and the sample size was determined when theoretical saturation was reached in the core category. Interpretive and theoretical validity were ensured through member checking, through the use of the constant comparative method, and by a review of the results by a panel of pharmacists and physicians. Ten participants aged between 41 and 64 years were included in the study sample. The participants had between one and 7 chronic illnesses, duration of these illnesses to date varied from 1 year to 40 years, and each participant was taking between one and 13 medications. A model was developed that consists of 4 thematic categories: (a) making sense of medication taking, (b) medication-taking acts, (c) mediation-taking self-assessment, and (d) context of medication taking. The main category was making sense of medication taking that consisted of 3 subcategories: (a) nonproblematic mode, (b) problematic mode, and (c) stunned mode. The model explains how and why a patients' need for medication-taking education may vary because their medication-taking practices changes. The model also connects each category to medication information that people may need. Findings contribute to our understanding of medication-taking practice of individuals on long-term medication and have

  5. Consulting in Collection Development.

    Science.gov (United States)

    Ash, Lee

    1980-01-01

    Considers the role of the consultant in the areas of library collection development and weeding, and offers suggestions on determining the need for a consultant, obtaining one, and what to do when the consultant arrives. (FM)

  6. The Study of Electronic Medical Record Adoption in a Medicare Certified Home Health Agency Using a Grounded Theory Approach

    Science.gov (United States)

    May, Joy L.

    2013-01-01

    The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences…

  7. Family physicians' effort to stay in charge of the medical treatment when patients have home care by district nurses. A grounded theory study

    Directory of Open Access Journals (Sweden)

    Hylander Ingrid

    2009-06-01

    Full Text Available Abstract Background District nurses (DNs provide home care for old persons with a mixture of chronic diseases, symptoms and reduced functional ability. Family physicians (FPs have been criticised for their lack of involvement in this care. The aim of this study was to obtain increased knowledge concerning the FP's experience of providing medical treatment for patients with home care provided by DNs by developing a theoretical model that elucidates how FPs handle the problems they encounter regarding the individual patients and their conditions. Methods Semi-structured interviews were conducted with 13 Swedish FPs concerning one of their registered patients with home care by a DN, and the treatment of this patient. Grounded theory methodology (GTM was used in the analyses. Results The core category was the effort to stay in charge of the medical treatment. This involved three types of problems: gaining sufficient insight, making adequate decisions, and maintaining appropriate medical treatment. For three categories of patients, the FPs had problems staying in charge. Patients with reduced functional ability had problems providing information and maintaining treatment. Patients who were "fixed in their ways" did not provide information and did not comply with recommendations, and for patients with complex conditions, making adequate decisions could be problematic. To overcome the problems, four different strategies were used: relying on information from others, supporting close observation and follow-up by others, being constantly ready to change the goal of the treatment, and relying on others to provide treatment. Conclusion The patients in this study differed from most other patients seen at the healthcare centre as the consultation with the patient could not provide the usual foundation for decisions concerning medical treatment. Information from and collaboration with the DN and other home care providers was essential for the FP's effort to

  8. 某院938例医务人员的药物咨询案例分析%Analysis of 938 Cases of Drug Consultation of Medical Staff in a Hospital

    Institute of Scientific and Technical Information of China (English)

    马燕; 何莲英

    2015-01-01

    The drug consultation cases of medical staff from June 1st of 2009 to May 31st of 2013 in one hospital were collected and analyzed statistically and the drug consultation of medical staff in hospital was summarized so as to find the entry point for further improvement of drug consultation. Pharmacist can provide pharmaceutical services in the aspects of drug interactions and incompatibility, usage and dosage, precautions for use, adverse drug reaction and medication in special people, etc.%收集某院2009年6月1日-2013年5月31日的医务人员药物咨询案例进行统计与分析。总结医院医务人员的药物咨询情况,为进一步改进药物咨询工作找到切入点。药师可以从药物相互作用与配伍禁忌、用法用量、使用注意事项、药品不良反应、特殊人群用药等方面开展药学服务工作。

  9. How doctors move from generic goals to specific communicative behavior in real practice consultations.

    Science.gov (United States)

    Veldhuijzen, Wemke; Mogendorff, Karen; Ram, Paul; van der Weijden, Trudy; Elwyn, Glyn; van der Vleuten, Cees

    2013-02-01

    To understand how recommendations for communication can be brought into alignment with clinical communication routines, we explored how doctors select communicative actions during consultations. We conducted stimulated recall interviews with 15 GPs (general practitioners), asking them to comment on recordings of two consultations. The data analysis was based on the principles of grounded theory. A model describing how doctors select communicative actions during consultations was developed. This model illustrates how GPs constantly adapt their selection of communicative actions to their evaluation of the situation. These evaluations culminate in the selection of situation-specific goals. These multiple and often dynamic goals require constant revision and adaptation of communication strategies, leading to constant readjustments of the selection of communicative actions. When selecting consultation goals GPs weigh patients' needs and preferences as well as the medical situation and its consequences. GPs' selection of communicative actions during consultations is situational and goal driven. To help doctors develop communicative competence tailored to the specific situation of each consultation, holistic communication training courses, which pay attention to the selection of consultation goals and matching communication strategies besides training specific communication skills, seem preferable to current generic communication skills training. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Free to become martyrs? The right to refuse medical treatment on religious grounds in a comparative perspective

    Directory of Open Access Journals (Sweden)

    Vincenzo Pacillo

    2016-09-01

     ABSTRACT: This study focuses on the right of patients to refuse medical treatments on religious grounds and on the (supposed right to the parents to refuse medical treatments on behalf of their children, emphasizing the links and connections between the freedom of religion, the right to self-determination and the right to refuse medical treatment based on religious motivations. After a comparison between the norms devoted to rule the exercise of these rights in the English (and Welsh and Italian legal systems, the article suggests that the approach of medical staff towards a Refusal of Medical Treatment on Religious Grounds ought to start an intercultural process. This process ought to be a cross-cultural dialogue devoted not only to translate medical language in a language which can be fully understood by the patient, but also to create a reciprocal comprehension between the (mainstream ethnocultural communication codes and instances of the staff and the (nondominant ethnocultural (and religious communication codes and instances of the patient (or of his/her parents.

  11. Who are we when we are doing what we are doing?: the case for mindful embodiment in ethics case consultation.

    Science.gov (United States)

    Frolic, Andrea

    2011-09-01

    This paper explores the theory and practice of embodied epistemology or mindful embodiment in ethics case consultation. I argue that not only is this epistemology an ethical imperative to safeguard the integrity of this emerging profession, but that it has the potential to improve the quality of ethics consultation (EC). It also has implications for how ethics consultants are trained and how consultation services are organized. My viewpoint is informed by ethnographic research and by my experimental application of mindful embodiment to the development of an ethics consultation service. My argument proceeds in four phases. First I explore the notion of 'situatedness' in the bioethics literature, identifying gaps in the field's theories as they apply to EC. I then describe my theoretical approach to embodiment grounded in critical-interpretive medical anthropology and autoethnography. I use embodiment to refer to a moral epistemology grounded in the body, comprised of the interplay of physical, symbolic, intersubjective and political elements. Third, I describe how mindful embodiment can inform the role of the ethics consultant and the development of effective training techniques, vocabularies and processes for EC. I also discuss the benefits of this orientation, and the potential harms of ignoring the embodied dimensions of EC. My goals are to expose the fallacy of the 'theory-practice gap', to demonstrate how my own EC practice is deeply informed by this theoretical orientation, and to argue for a wider definition of what 'counts' as relevant theory for ethics consultation.

  12. On-the-Job Ethics – Proximity Morality Forming in Medical School: A grounded theory analysis using survey data

    Directory of Open Access Journals (Sweden)

    Hans O. Thulesius, MD, Ph.D.

    2009-03-01

    Full Text Available On-the-job-ethics exist in all businesses and can also be called proximity morality forming. In this paper we propose that medical students take a proximity morality stance towards ethics education at medical school. This means that they want to form physician morality “on the job” instead of being taught ethics like any other subject. On-the-job-ethics for medical students involves learning ethics that is used when practicing ethics. Learning ethics includes comprehensive ethics courses in which quality lectures provide ethics grammar useful for the ethics practicing in attitude exercises and vignette reflections in tutored group discussions. On-the-job-ethics develops professional identity, handles diversity of religious and existential worldviews, trains students described as ethically naive, processes difficult clinical experiences, and desists negative role modeling from physicians in clinical or teaching situations. This grounded theory analysis was made from a questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed over 8000 words of open-ended responses and multiplechoice questions using classic grounded theory procedures, but also compared questionnaire data using statistics such as multiple regression models. The paper gives an example of how grounded theory can be used with a limited amount of survey data.

  13. 药师参与临床会诊及制订用药方案的实践与体会%Practice and Experience of Pharmacist Participating in Clinical Consultation and Medication Scheme Design

    Institute of Scientific and Technical Information of China (English)

    孙为民; 李明; 郑志昌; 杨继红

    2012-01-01

    OBJECTIVE: To investigate the experience of clinical pharmacist participating in clinical consultation and medication scheme design. METHODS: The cases of clinical pharmacists participating in clinical consultation and assisting clinical physicians to make individualized medication scheme were analyzed. RESULTS&CONCLUSION: Clinical pharmacists use their pharmaceutical professional skill, put forward suggestions for treatment, reduce the occurrence of ADR and improve drug therapy by participating in clinical consultation.%目的:探讨药师深入临床参与临床会诊、制订用药方案的经验与体会.方法:对药师参与临床会诊及协助医师进行个体化给药的案例进行分析.结果与结论:药师通过参与临床会诊,发挥药学专长,提出合理的药物治疗建议,减少了药品不良反应的发生,提高了药物治疗水平.

  14. Resourcing the clinical complementary medicine information needs of Australian medical students: Results of a grounded theory study.

    Science.gov (United States)

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2016-09-01

    The aim of this study was to identify Australian medical students' complementary medicine information needs. Thirty medical students from 10 medical education faculties across Australian universities were recruited. Data were generated using in-depth semi-structured interviews and constructivist grounded theory method was used to analyze and construct data. Students sought complementary medicine information from a range of inadequate sources, such as pharmacological texts, Internet searches, peer-reviewed medical journals, and drug databases. The students identified that many complementary medicine resources may not be regarded as objective, reliable, differentiated, or comprehensive, leaving much that medical education needs to address. Most students sought succinct, easily accessible, evidence-based information to inform safe and appropriate clinical decisions about complementary medicines. A number of preferred resources were identified that can be recommended and actively promoted to medical students. Therefore, specific, evidence-based complementary medicine databases and secondary resources should be subscribed and recommended to medical schools and students, to assist meeting professional responsibilities regarding complementary medicines. These findings may help inform the development of appropriate medical information resources regarding complementary medicines. © 2016 John Wiley & Sons Australia, Ltd.

  15. The effect of parallel consulting on the quality of consultations in regional general practice.

    Science.gov (United States)

    Tran, Peter Duy; Laurence, Jerome Martin; Weston, Kathryn M; McLennan, Peter L

    2012-05-01

    The sustainability of community-based medical education relies on maintaining consultation quality as perceived by patients. This study aims to investigate the effect of an alternative model (parallel consultation) of teaching on patients' views of consultation quality as compared to the conventional consultation model in a general practice setting. A cross-sectional questionnaire study. Patients attending a regional general practice in the Southern Highlands of New South Wales between February and May 2010, who consented to student involvement in their consultation. Instruments to measure 'empathy' (CARE score) and 'enablement' (PEI score) as markers for consultation quality were administered after patient consultations. There was no difference in consultation length between the two groups. There was a small increase in the level of empathy experienced by patients attending parallel consultations compared to conventional consultations (Pconsultation group (Pconsultation quality, as experienced by the patient, when using the parallel consulting model. Parallel consulting does not change the length of time a patient spends with their doctor, and patients have a positive perception of the students involved in this model of clinical teaching.

  16. Psychiatric consultations and the management of associated ...

    African Journals Online (AJOL)

    as delirium, dementia, psychotic disorders due to general medical ... comorbid medical conditions in a regional referral hospital ... (10.0% of cases consulted) were admitted to either the medical or psychiatric wards with a confirmed diagnosis of delirium, .... and Emergency Services (535; 89); Internal Medicine including.

  17. Audit of the consultation process on general internal medicine services.

    Science.gov (United States)

    Conley, J; Jordan, M; Ghali, W A

    2009-02-01

    To determine the proportion of consultations requested by general internal medicine services that communicate key components of the consultation process to medical subspecialists. Retrospective chart review by two researchers, using a standardised chart abstraction instrument (93.1% agreement, kappa 0.85). Calgary, Alberta, Canada. A random sample of medical consultations was selected from those generated on two medical teaching units (MTUs) from 2003 to 2004. The primary measure of interest was whether a "clear clinical question" was posed to the subspecialist, a binary variable. Two hundred consultations were sampled from the 2885 subspecialty consultations. Of the selected consultations, 94.0% (188/200) were available for review. A clear clinical question was posed in 69.7% (131/188) of consultations (CI 0.63 to 0.74). In a secondary analysis involving a larger sample permitting comparison across subspecialties, 95.1% (368/387) of the consultations, representative of the subspecialties, were available for review. An MTU member contacted the subspecialist for 74.2% of consultations. If a consultation was urgent, a member of the MTU contacted the subspecialist in 81.0% of consultations. Of these urgent consultations, 63.3% had a clear clinical question. More than one in four consultations does not contain a clear clinical question, illustrating suboptimal communication between physicians. Innovative strategies that provide a sustainable solution for overcoming barriers to communication could have a significant impact on quality of care.

  18. Burial Ground Expansion Hydrogeologic Characterization

    Energy Technology Data Exchange (ETDEWEB)

    Gaughan , T.F.

    1999-02-26

    Sirrine Environmental Consultants provided technical oversight of the installation of eighteen groundwater monitoring wells and six exploratory borings around the location of the Burial Ground Expansion.

  19. 新版电子病历系统与远程医疗会诊系统融合分析%Fusion Analysis of Electronic Medical Records System and Telemedicine Consultation System

    Institute of Scientific and Technical Information of China (English)

    张文博; 罗娟; 唐晓东; 孙新; 赵振华

    2013-01-01

      分析远程医疗会诊系统的现状及不足,阐述新版电子病历的优势,利用二者在信息利用上的互补性,技术结构、网络链接上的互通性,从病历信息、实时控制、辅助决策等方面进行有效融合,必将在提高会诊质量和效率,提升医疗满意度等方面取得较好的应用效果。%To analyze the current situation and shortages of telemedicine consultation system ,and elaborate the advantages of electronic medical records ,then make effective integration from aspects of medical record information ,real-time control and auxiliary decision depending on their information-using complementarity ,interoperability of technology structure and network link .This will has an important meaning of enhancing consultative quality and efficiency ,achieve better effect in improving medical treatment satis - faction .

  20. Tribal Consultation Tracking System

    Data.gov (United States)

    U.S. Environmental Protection Agency — The consultation-related information the AIEO Consultation Team working with our Tribal Portal contractors has developed a Lotus Notes Database that is capable of...

  1. Campaign Consultants - Client Payments

    Data.gov (United States)

    City of San Francisco — Campaign Consultants are required to report ���economic consideration�۝ promised by or received from clients in exchange for campaign consulting services during the...

  2. Timer: a new objective measure of consultation content and its application to computer assisted consultations.

    Science.gov (United States)

    Pringle, M; Robins, S; Brown, G

    1986-01-01

    As part of the research into the effect in the consultation of the use of a computer to prompt opportunistic preventive care a valid, objective, and practical measure of the consultation process was required. After a review of the alternative methods the Time Interval Medical Event Recorder (Timer) was developed, its reliability tested, and applied to 93 control consultations and 49 computer assisted consultations. Timer records, every five seconds, four consultation events: the problems being dealt with, the physical activity, the verbal activity, and the secondary tasks being attempted. Timer showed that control consultations lasted an average of 6 minutes 58 seconds. The doctors spent 35% of their time on administration, and patients and doctors were both conversational for just 33% of the consultation. Giving information was the most common verbal activity (48% of the duration of the consultation) with silence accounting for 21% of the time. When the computer was used the average consultation was longer, at 7 minutes and 46 seconds. The doctor's contribution to the consultation appeared to have increased. Patient centred speech fell from 36% in controls to 28% of the duration of the consultation when the computer was used, while doctor centred speech rose from 30% to 34.5%. Secondary tasks (exploring patient concepts, education, management sharing, and prevention) were attempted during 28% of the control consultations and 40% of the computer consultations. This was accounted for by the increase in prevention (p less than 0.001). Timer is a reliable and practical tool for researching the consultation, and though it has shown validity in detecting differences between consultations that use a computer and those that do not, further applications are required to establish its full value. PMID:3089391

  3. Teaching CONSULT: Consultation with Novel methods & Simulation for UME Longitudinal Training.

    Directory of Open Access Journals (Sweden)

    Keme Carter

    2015-10-01

    consultation process (0% vs. 69%, p<0.001. Post- curriculum, fourth-year students scored higher in all criteria measuring consultation effectiveness (p<0.001 for all and included more necessary items in simulated consultations (62% vs. 77%, p<0.001. Conclusion: While third-year medical students reported calling consultations, few felt comfortable and formal training was lacking. A curriculum in consult communication for different levels of learners can improve knowledge and comfort prior to clinical clerkships and improve consultation skills prior to residency training.

  4. Wartime Toxicology: Evaluation of a Military Medical Toxicology Telemedicine Consults Service to Assist Physicians Serving Overseas and in Combat (2005-2012)

    Science.gov (United States)

    2014-04-22

    emer- gencies. For example, in a case of organophosphate poison - ing, the toxicologists responded in 42 min, and while the patient did well, a 42-min...Bebarta e-mail: vikbebarta@yahoo.com K. Heard Rocky Mountain Poison and Drug Center, Denver, CO, USA e-mail: Kennon.heard@ucdenver.edu C. Lappan...toxicologist consulted made the diagnosis of lead poisoning and recommended che- lation with dimercaprol and ethylenediaminetetraacetic acid. The

  5. Optimizing Consulting Delivery Systems.

    Science.gov (United States)

    Spottswood, Curran

    1980-01-01

    Summarizes a study of several types of consulting groups in the Bell System and describes characteristics which are associated with high-impact consulting. A strategy which is designed for internal consulting organizations to maximize the likelihood of both initial success and long-term survival of the group is proposed. (Author/MER)

  6. Bioethics Consultations and Resources

    OpenAIRE

    Thomas, Jennie

    2011-01-01

    Making difficult healthcare decisions is often helped by consultation with a bioethics committee. This article reviews the main bioethics principles, when it is appropriate and how to call a bioethics consult, ethical concerns, and members of the consult team. Bioethics resources are included.

  7. Comparison of helicopter and ground emergency medical service: a retrospective analysis of a German rescue helicopter base.

    Science.gov (United States)

    Mommsen, Philipp; Bradt, Nikolas; Zeckey, Christian; Andruszkow, Hagen; Petri, Max; Frink, Michael; Hildebrand, Frank; Krettek, Christian; Probst, Christian

    2012-01-01

    In consideration of rising cost pressure in the German health care system, the usefulness of helicopter emergency medical service (HEMS) in terms of time- and cost-effectiveness is controversially discussed. The aim of the present study was to investigate whether HEMS is associated with significantly decreased arrival and transportation times compared to ground EMS. In a retrospective study, we evaluated 1,548 primary emergency missions for time sensitive diagnoses (multiple trauma, traumatic brain and burn injury, heart-attack, stroke, and pediatric emergency) performed by a German HEMS using the medical database, NADIN, of the German Air Rescue Service. Arrival and transportation times were compared to calculated ground EMS times. HEMS showed significantly reduced arrival times at the scene in case of heart-attack, stroke and pediatric emergencies. In contrast, HEMS and ground EMS showed comparable arrival times in patients with multiple trauma, traumatic brain and burn injury due to an increased flight distance. HEMS showed a significantly decreased transportation time to the closest centre capable of specialist care in all diagnosis groups (pambulance services with significantly decreased transportation times.

  8. 优化三个系统发展咨询服务——上海市医疗保障咨询服务热线运行管理纪实%Optimization Three Eystem Construction and Development of Medical Insurance Consulting Services

    Institute of Scientific and Technical Information of China (English)

    周骥

    2012-01-01

      上海市医疗保险咨询服务紧紧围绕人民群众关注的医保民生问题,不断提升和优化医保咨询服务运行管理系统、医保咨询服务能力系统和医保咨询服务技术支持系统等三个系统的建设,做好医保政策和经办服务的咨询、宣传工作,促进了全市医保工作的平稳运行。%  The Shanghai medical insurance consulting services centering on people's attention livelihood of the people question medical insurance, and constantly improve and optimize the construction of the medical insurance consulting service operation management system, medical insurance consulting service capacity system and medical insurance consulting services technical support system, completes the medical insurance policy and organization of service of consulting, propaganda, has promoted the Medical insurance affairs running healthy and smoothly.

  9. Proximity morality in medical school – medical students forming physician morality "on the job": Grounded theory analysis of a student survey

    Directory of Open Access Journals (Sweden)

    Sallin Karl

    2007-08-01

    Full Text Available Abstract Background The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools. Methods Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures. Results In this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes. Conclusion We found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.

  10. Proximity morality in medical school--medical students forming physician morality "on the job": grounded theory analysis of a student survey.

    Science.gov (United States)

    Thulesius, Hans O; Sallin, Karl; Lynoe, Niels; Löfmark, Rurik

    2007-08-06

    The value of ethics education have been questioned. Therefore we did a student survey on attitudes about the teaching of ethics in Swedish medical schools. Questionnaire survey on attitudes to ethics education with 409 Swedish medical students participating. We analyzed > 8000 words of open-ended responses and multiple-choice questions using classic grounded theory procedures. In this paper we suggest that medical students take a proximity morality stance towards their ethics education meaning that they want to form physician morality "on the job". This involves comprehensive ethics courses in which quality lectures provide "ethics grammar" and together with attitude exercises and vignette reflections nurture tutored group discussions. Goals of forming physician morality are to develop a professional identity, handling diversity of religious and existential worldviews, training students described as ethically naive, processing difficult clinical experiences, and desisting negative role modeling from physicians in clinical or teaching situations, some engaging in "ethics suppression" by controlling sensitive topic discussions and serving students politically correct attitudes. We found that medical students have a proximity morality attitude towards ethics education. Rather than being taught ethics they want to form their own physician morality through tutored group discussions in comprehensive ethics courses.

  11. Consulting on Academic Library Buildings.

    Science.gov (United States)

    Mason, Ellsworth

    1980-01-01

    Addresses the following aspects of consulting on library buildings: new trends, the need for a consultant, selecting a consultant, timeliness in hiring, expectations, following through, and the cost of consulting. (FM)

  12. Making sense of medically unexplained symptoms in general practice: a grounded theory study

    OpenAIRE

    Stone, Louise

    2013-01-01

    Background General practitioners often encounter patients with medically unexplained symptoms. These patients share many common features, but there is little agreement about the best diagnostic framework for describing them.

  13. Designing consultancy on energy

    Energy Technology Data Exchange (ETDEWEB)

    Nielsen, Lene [Danish Energy Authority, Copenhagen (Denmark)

    2005-07-01

    There is a wide tradition for using energy consultancy in all end-using sectors and in various models. A lot of aspects have to be taken into consideration when a consultant scheme is to be launched. This paper will contribute to the discussion of the role of the consultant in the different energy end-use sectors: Energy consultancy is defined. The process for energy consulting is related to the eight fundamental objectives for effective management consulting (Arthur N. Turner): responding to a client's request for information; providing solutions to specific problems; giving an in-depth, accurate diagnosis; presenting a program of recommended corrective actions; implementing changes; building consensus and commitment; facilitating client learning; and enhancing organizational effectiveness. The role of the consultant is divided into 4 categories (expert, diagnostician, sparring partner, process consultant) depending on the consultant's focus (process or cases) and methodology (analysis or dialogue). Designing energy consultancy should reflect the end-use sector (household, industry etc.)

  14. The Process of Parents' Decision-Making to Discharge Their Child against Medical Advice (DAMA: A grounded theory study

    Directory of Open Access Journals (Sweden)

    Nikbakht Nasrabadi Alireza

    2016-05-01

    Full Text Available Discharge against medical advice (DAMA refers to the phenomenon that patient or the patient’s surrogate decides to leave the hospital before the attending physician confirms the patient is discharged. Children are much more vulnerable to such discharges. This process occurs with different mechanisms that identifying them can be helpful in reducing this phenomenon. We aimed to explore the process of parents' decision-making to discharge their child against medical advice. In-depth, semi-structured interviews were conducted with 10 fathers, 10 mothers, 6 nurses and 3 physician assistants and the data were collected to the point of saturation. Grounded theory methodology was adopted for data collection and analysis. The results of qualitative analysis in the field of the parents' decisionmaking on the DAMA revealed 4 main themes: "lack of family-centered care", "disruption of the parenting process", "distrust to the medical team and center" and "psychological strategy of shirk responsibility for child care and treatment ". By providing family-centered care, adopting measures to empowering the families, developing the trust of parents to the health care team and developing a discharge plan from the beginning of children hospitalization with the cooperation of health care team and parents and considering all factors such as child's special health condition and parent's health related perceptions and beliefs, children will not be discharged against medical advice and will experience better outcomes.

  15. Practice and Experience of Medication Consultation Wechat Platform in Our Hospital%我院用药咨询微信平台建设的实践与体会

    Institute of Scientific and Technical Information of China (English)

    李丽莉; 金锐; 孙路路

    2016-01-01

    OBJECTIVE:To provide reference for medication consultation Wechat platform in the hospital. METHODS:The medication consultation Wechat platform of our hospital was introduced,including main method,content and effect. The consulting pharmacist team was set up,and Wechat public number was applied and operated experimentally;information pharmacist was re-sponsible for its daily maintenance. We released pharmacy news,accumulated consumers and expanded influence through other me-dia at regular intervals. RESULTS & CONCLUSIONS:According to the medical practice,two modules“medication consultation”and“pharmacy news”were set up. From Dec. 2014 to Jul. 30th 2015,medication consultation system had accumulated 1 121 con-sumers,with an increase of 5 to 8 ones everyday;average number of consultation records was 10 everyday;we also had published 22 batch of medication news(79 messages),including 31 original messages and 3 video messages. Several messages gained much attention from network media and offline media. As new pharmaceutical care mode,Wechat platform contribute to realize a individ-ual,convenient and mobile medication consultation service,medication health science popularization,and improves medication compliance of patients and the awareness of medication safety in field of pharmaceutical administration Wechat platform,so as to improve pharmaceutical care effect of“taking patients as the center”and promote the propaganda of hospital brand. Thus it has a good prospect of application and popularization.%目的:为医院创建用药咨询微信服务平台提供参考。方法:介绍我院创建用药咨询微信服务平台的主要实践方法、内容及效果。具体包括成立用药咨询药师小组、申请微信公众号并试运营,由信息药师负责运营;定期推送药学资讯,积累用药咨询用户,并通过其他媒介扩大影响。结果与结论:基于用药咨询实际,构建“用药咨询”和“药学资讯

  16. Developing a grounded theory for interprofessional collaboration acquisition using facilitator and actor perspectives in simulated wilderness medical emergencies.

    Science.gov (United States)

    Smith, Heather A; Reade, Maurianne; Marr, Marion; Jeeves, Nicholas

    2017-01-01

    Interprofessional collaboration is a complex process that has the potential to transform patient care for the better in urban, rural and remote healthcare settings. Simulation has been found to improve participants' interprofessional competencies, but the mechanisms by which interprofessionalism is learned have yet to be understood. A rural wilderness medicine conference (WildER Med) in northern Ontario, Canada with simulated medical scenarios has been demonstrated to be effective in improving participants' collaboration without formal interprofessional education (IPE) curriculum. Interprofessionalism may be taught through rural and remote medical simulation, as done in WildER Med where participants' interprofessional competencies improved without any formal IPE curriculum. This learning may be attributed to the informal and hidden curriculum. Understanding the mechanism by which this rural educational experience contributed to participants' learning to collaborate requires insight into the events before, during and after the simulations. The authors drew upon feedback from facilitators and patient actors in one-on-one interviews to develop a grounded theory for how collaboration is taught and learned. Sharing emerged as the core concept of a grounded theory to explain how team members acquired interprofessional collaboration competencies. Sharing was enacted through the strategies of developing common goals, sharing leadership, and developing mutual respect and understanding. Further analysis of the data and literature suggests that the social wilderness environment was foundational in enabling sharing to occur. Medical simulations in other rural and remote settings may offer an environment conducive to collaboration and be effective in teaching collaboration. When designing interprofessional education, health educators should consider using emergency response teams or rural community health teams to optimize the informal and hidden curriculum contributing to

  17. Discussion on Performance Management Mode of Medication Consultation Service in Our Hospital%我院用药咨询服务绩效管理模式的探讨

    Institute of Scientific and Technical Information of China (English)

    所伟; 石秀锦; 周洋; 林阳

    2016-01-01

    目的:探讨绩效管理在改进医院用药咨询服务中的作用,促进用药咨询中心服务质量的提高.方法:介绍我院用药咨询中心从业务技能、人文素养、工作态度、工作量4个维度制订咨询药师绩效评估内容与核算细则,并从日常评估检查、开展培训活动、制订发展规划等方面实施绩效管理的模式,再对该模式进行效果评价.结果:绩效评估中业务技能、人文素养、工作态度、工作量各占20、15、15、50分,其下又分为16个具体项目及加分项.实施上述绩效管理后,用药咨询周均服务人次由104人增长到247人(增长了138%),药师主动进行患者用药宣教的比例从18.30%增长至46.34%(增长了153%),用药咨询中涉及复杂及专业的问题如药物相互作用问题由0.96%上升至5.28%、药物用法用量问题由6.73%上升至23.17%.该模式不但增强了咨询药师的服务意识与积极性,而且提升了其药学服务水平.结论:运用合理、有效的绩效管理模式可提升用药咨询中心的服务质量和服务能力,促进其在医院药学服务中发挥更大作用.%OBJECTIVE:To discuss the effect of performance management in medication consultation service in hospital,and to improve the service quality in medication consultation center. METHODS:The performance management mode of medication consultation center was implemented in our hospital through formulating consultation pharmacist performance evaluation content and accounting rules from four dimensions of business skills,cultural literacy,work attitude,workload,conducting daily evaluation and check,developing training,setting development plan,etc. The effects of the mode were evaluated. RESULTS:In performance evaluation,business skills,cultural literacy,work attitude and workload took up 20,15,15 and 50 points,respectively;they were subdivided into 16 specific items and extra point items. After the implementation of above performance management

  18. The value of peri-operative consultation on a general surgical ward by the internist

    NARCIS (Netherlands)

    Mollema, R; Berger, P.; Girbes, ARJ

    2000-01-01

    Background: Medical peri-operative consultation plays an important role in the practice of the internist. It represents 13-33% of the total consultation done by the internist. The value of preoperative consultation by the internist is still unclear and the place of the consultations is under discuss

  19. A proposal for a behavioral pre-consultation: Analysis of the use of a protocol during consultations

    OpenAIRE

    Kohlsdorf,Marina; Costa Junior,Áderson Luiz

    2015-01-01

    This study aimed to analyze how physicians, caregivers, and children use protocols regarding estimated issues to medical visits, procedure named pre-consultation lists, along treatment for childhood cancer. Three pediatricians and 24 dyads child-caregiver took part; each pair was interviewed before medical visits in order to report doubts, needs and issues estimated to the consultation. This list was attached to child's medical record as a memo of themes to discuss in the next medical visit. ...

  20. The Dream Consultant

    DEFF Research Database (Denmark)

    Muhr, Sara Louise; Kirkegaard, Line

    2013-01-01

    for work. We draw on Lacan's notion of desire as the Other's desire and analyze the consultants' desire as controlled by a need for recognition at work. We show how consultants need off-work fantasies to maintain the illusion of wholeness – of being more than work. Only with this illusion of wholeness can...

  1. The Contemporary Consultant

    DEFF Research Database (Denmark)

    Olson, Thomas; Poulfelt, Flemming; Greiner, Larry

    This book complements The handbook of Management Consulting: The Contemporary Consultant: Insights from Leading Experts, 1e but can also be studied separately. The book consists of 20 cases including Harvard and Stanford cases. The cases present the broad range of topics that are pertinent...

  2. Why are junior doctors reluctant to consult attending physicians?

    Science.gov (United States)

    Swank, Otto H

    2010-03-01

    A physician performs two tasks: making diagnoses and determining treatments. To reduce medical error, junior doctors are supposed to consult their supervisors when they face uncommon circumstances. However, recent research shows that junior doctors are reluctant to do so. This paper presents a model that explains (i) which junior doctors shy away from consulting; (ii) when junior doctors are reluctant; (iii) the importance of protocols in the medical sector; and (iv) when consulting is a sign of strength or a sign of weakness. Furthermore, I show that encouraging junior doctors to consult by investigating mishaps leads to another distortion: they will give too much weight to own assessments.

  3. Practical guidance for charting ethics consultations.

    Science.gov (United States)

    Bruce, Courtenay R; Smith, Martin L; Tawose, Olubukunola Mary; Sharp, Richard R

    2014-03-01

    It is generally accepted that appropriate documentation of activities and recommendations of ethics consultants in patients' medical records is critical. Despite this acceptance, the bioethics literature is largely devoid of guidance on key elements of an ethics chart note, the degree of specificity that it should contain, and its stylistic tenor. We aim to provide guidance for a variety of persons engaged in clinical ethics consultation: new and seasoned ethics committee members who are new to ethics consultation, students and trainees in clinical ethics, and those who have significant experience with ethics consultation so that they can reflect on their practice. Toward the goal of promoting quality charting practices in ethics consultations, we propose recommendations on a broad array of questions concerning clinical ethics consultation chart notes, including whether and when to write a chart note, and practical considerations for the tenor, purpose, and content of a chart note. Our broader aim is to promote discussion about good charting practices in clinical ethics, with the hope of contributing to clear standards of excellence in clinical ethics consultation.

  4. US-USSR telemedicine consultation spacebridge to Armenia and Ufa

    Science.gov (United States)

    1991-01-01

    The Final Report on the U.S.-U.S.S.R. Telemedicine Consultation Spacebride to Armenia and Ufa is presented. The goal of this activity was to provide expert medical consultation to the Armenian medical personnel in the areas of plastic and reconstructive surgery, physical and psychological rehabilitation, public health, and epidemiology following the devastating earthquake in Dec. 1988. The U.S. and U.S.S.R. implementation teams developed new standards for medical information transmittal as well as protocols and schedules on how to conduct medical consultations. The consultations were provided to the Republic Diagnostic Center in Yerevan, U.S.S.R. by four U.S. medical centers: University of Utah/LDS Hospital, University of Texas, Maryland Institute for Emergency Medical Service Systems, and Uniformed Services University of the Health Sciences.

  5. IT Consultants in Acquisition IT Integration

    DEFF Research Database (Denmark)

    Henningsson, Stefan; Øhrgaard, Christian

    2016-01-01

    ’s IT following a corporate acquisition, presents a difficult but crucial IT challenge for the many acquiring organizations. Through a comparative case study of four acquirers, theoretically grounded in the resource-based view of the firm, it is analyzed how acquirers draw on external consultants to realize...... model, depicting the use of external consultants in acquisition IT integration, contributes to the literature on acquisition IT integration by providing an explanation for IT-based value creation in acquisition that is rooted in the external of the acquirer. In addition to adding to the limited...

  6. Principles of effective consultation: an update for the 21st-century consultant.

    Science.gov (United States)

    Salerno, Stephen M; Hurst, Frank P; Halvorson, Stephanie; Mercado, Donna L

    2007-02-12

    Little information in the literature exists to guide consult interactions between different medical specialties. A total of 323 general internists, family medicine physicians, general surgeons, orthopedic surgeons, and obstetricians/gynecologists (OB/GYNs) from 3 academic medical centers completed a survey addressing their ideal relationship with consultants. Differences between surgeons and nonsurgeons were calculated using logistic regression, adjusting for location and trainee status. Differences between different specialties of surgeons were calculated using analysis of variance with Scheffe post hoc analysis There was a 72% response rate. About half of respondents were surgeons and the rest were general internists and family medicine physicians. More nonsurgeons (69%) desired the consultant to focus on a narrow question than did surgeons (41%). Over half (59%) of family medicine physicians and internists preferred to retain order-writing authority on their patients compared with 37% of surgeons (Pinternal medicine input, preferring to consult medicine subspecialists directly. Specialty-dependent differences exist in consult preferences of physicians. These differences vary from the extremes of orthopedic surgeons desiring a comprehensive co-management approach with the consultant to general internists and family medicine physicians desiring to retain control over order writing and have a more focused consultant approach.

  7. Family Practice Consultation.

    African Journals Online (AJOL)

    gauge the patients' opin:on on the family doctors' role regardirg prayer ... family practice consultation arc presented. ... patients' expectation of prayer and ..... New developments and frequently asked questions covering - high and low BMI, ...

  8. 以信息技术提升医院会诊时效性的实践%Our practice of improving timeliness of hospital medical consultation with information technology

    Institute of Scientific and Technical Information of China (English)

    陈立新; 冷金昌; 成琛

    2012-01-01

    为确保会诊申请、会诊执行、会诊效果的及时有效,在分析影响会诊时效各种因素的基础上,研发了会诊信息系统.经运行证明,该系统有效提高了会诊质量和时效性,也为管理部门评价会诊质量提供了客观依据.%To ensure timely and effective consultation application, consultation execution and consultation effect, we have researched and developed a consultation information system based on analysis of various factors affecting timeliness of consultation. The operation proves that this system can effectively improve the quality and timeliness of consultation and provide an objective basis for the administrative department to evaluate quality consultation.

  9. STATE AND DEVELOPMENT PROSPECTS OF GERMANY CONSULTING MARKET IN THE CONTEXT OF EUROPE-WIDE TRENDS

    Directory of Open Access Journals (Sweden)

    K. Kovalska

    2014-09-01

    Full Text Available The paper deals with the actual state of consulting market in Germany. The structural configuration of the Germany consulting market on functional grounds, with the customer's branch, as well as geographically were analyzed. The main prospects of German consulting market development in the context of Europe-wide trends have been defined.

  10. Shared consultant physician posts.

    LENUS (Irish Health Repository)

    Cooke, J

    2012-01-31

    Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.

  11. Palliative treatment alternatives and euthanasia consultations: a qualitative interview study.

    Science.gov (United States)

    Buiting, Hilde M; Willems, Dick L; Pasman, H Roeline W; Rurup, Mette L; Onwuteaka-Philipsen, Bregje D

    2011-07-01

    medical and ethical debate is needed to determine consultants' most appropriate role. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  12. Sexual behaviour of men that consulted in medical outpatient clinics in Western Switzerland from 2005-2006: risk levels unknown to doctors?

    Directory of Open Access Journals (Sweden)

    Dubois-Arber Françoise

    2010-09-01

    Full Text Available Abstract Background To determine male outpatient attenders' sexual behaviours, expectations and experience of talking about their sexuality and sexual health needs with a doctor. Methods A survey was conducted among all male patients aged 18-70, recruited from the two main medical outpatient clinics in Lausanne, Switzerland, in 2005-2006. The anonymous self-administered questionnaire included questions on sexual behaviour, HIV/STI information needs, expectations and experiences regarding discussion of sexual matters with a doctor. Results The response rate was 53.0% (N = 1452. The mean age was 37.7 years. Overall, 13.4% of patients were defined as at STI risk - i.e. having not consistently used condoms with casual partners in the last 6 months, or with a paid partner during the last intercourse - regarding their sexual behaviour in the last year. 90.9% would have liked their physician to ask them questions concerning their sexual life; only 61.4% had ever had such a discussion. The multivariate analysis showed that patients at risk tended to have the following characteristics: recruited from the HIV testing clinic, lived alone, declared no religion, had a low level of education, felt uninformed about HIV/AIDS, were younger, had had concurrent sexual partners in the last 12 months. However they were not more likely to have discussed sexual matters with their doctor than patients not at risk. Conclusion Recording the sexual history and advice on the prevention of the risks of STI should become routine practice for primary health care doctors.

  13. Medical Illustration

    Science.gov (United States)

    ... Accredited programs prepare students for a career in academic or research health science centers, industry, or consulting. As members of the health career profession with strong communication skills, medical illustrators work closely with clients to interpret ...

  14. Exploration Medical System Demonstration Project

    Science.gov (United States)

    Chin, D. A.; McGrath, T. L.; Reyna, B.; Watkins, S. D.

    2011-01-01

    A near-Earth Asteroid (NEA) mission will present significant new challenges including hazards to crew health created by exploring a beyond low earth orbit destination, traversing the terrain of asteroid surfaces, and the effects of variable gravity environments. Limited communications with ground-based personnel for diagnosis and consultation of medical events require increased crew autonomy when diagnosing conditions, creating treatment plans, and executing procedures. Scope: The Exploration Medical System Demonstration (EMSD) project will be a test bed on the International Space Station (ISS) to show an end-to-end medical system assisting the Crew Medical Officers (CMO) in optimizing medical care delivery and medical data management during a mission. NEA medical care challenges include resource and resupply constraints limiting the extent to which medical conditions can be treated, inability to evacuate to Earth during many mission phases, and rendering of medical care by a non-clinician. The system demonstrates the integration of medical technologies and medical informatics tools for managing evidence and decision making. Project Objectives: The objectives of the EMSD project are to: a) Reduce and possibly eliminate the time required for a crewmember and ground personnel to manage medical data from one application to another. b) Demonstrate crewmember's ability to access medical data/information via a software solution to assist/aid in the treatment of a medical condition. c) Develop a common data management architecture that can be ubiquitously used to automate repetitive data collection, management, and communications tasks for all crew health and life sciences activities. d) Develop a common data management architecture that allows for scalability, extensibility, and interoperability of data sources and data users. e) Lower total cost of ownership for development and sustainment of peripheral hardware and software that use EMSD for data management f) Provide

  15. Nurse consultants: organizational influences on role achievement.

    Science.gov (United States)

    Woodward, Valerie A; Webb, Christine; Prowse, Morag

    2006-03-01

    This paper reports on organizational influences on nurse consultant post holders. The influence of individual characteristics has been the subject of another paper. Nurse consultant posts were set up in the United Kingdom from the late 1990s onwards and, therefore, there has been little opportunity to report on evaluations of these innovative initiatives. A cross-sectional design, using a convenience sample, was adopted. Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. Support systems were important influences on nurse consultants' role achievement levels. These took the form of internal trust networks, nurse consultant forums and links with higher education institutions. Post holders both gave and received support and acted to empower other nurses. Thus, relationships were vital to successful role integration. The culture and structures of the National Health System were also a powerful influence in terms of local and national modernization policies, and participants had to be careful in their choice of strategies to deal with the traditional medically dominated culture. The new nurse consultant role is challenging and innovative, but a major area of contention is how much post holders are expected to take on work previously done by doctors rather than developing their nursing role. Organizational support and commitment are needed if nurse consultants are to maximize the benefits of this innovation. The findings show that new nursing roles are not always easily accepted in multidisciplinary settings and that holders of such post need to have the appropriate previous knowledge, skills and personal characteristics, as well as the ability to negotiate their way through organizational influences.

  16. Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians.

    Science.gov (United States)

    Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith

    2014-01-01

    Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

  17. Nurse consultants 10 years on: an insight to the role for nurse managers.

    Science.gov (United States)

    Mullen, Chris; Gavin-Daley, Ann; Kilgannon, Helen; Swift, Juliette

    2011-09-01

    To evaluate the Non-Medical Consultant role in the North West of England. The objective was to identify the current number of Non-Medical Consultants, what they do and the impact of the role in practice. The Non-Medical Consultant role for nursing and midwifery was introduced in the UK in 2000 to provide better outcomes for patients by improving service and quality; strengthening clinical leadership; and providing a new career opportunity to help retain experienced and expert professionals in practice. A combined qualitative and quantitative design was adopted. This included desktop review of previous studies, a survey questionnaire to current consultants, focus group meetings with Non-Medical Consultants, sponsors and champions. The role is effective, flexible, responsive and outward facing both internal to the organization and externally on a local, regional and national basis. A key challenge for the Non-Medical Consultants was organizational understanding of the role. The small size of the Non-Medical Consultant workforce can limit individual organizations experience of establishing and supporting the role. Effective Non-Medical Consultants lead, drive and support quality improvement, increased productivity and service effectiveness. Other impacts include sharing and promoting best practice with colleagues, income generation and financial savings through service redesign and/or staff skill mix changes. Managerial issues identified may assist Nurse Managers seeking to introduce new consultant roles and/or support, and retain existing consultants to reach their full potential. 2011 Blackwell Publishing Ltd.

  18. Mentoring for new consultants.

    Science.gov (United States)

    Ackroyd, R; Adamson, K A

    2015-01-01

    There is increasing evidence of the benefits of having a mentor during the early years as a consultant. Mentoring encourages and provides support to an individual in their professional development. Although there are different forms of mentoring there is recognition that developing a formal mentoring scheme can provide a consistent approach and support within a framework. The Royal College of Physicians of Edinburgh has introduced a mentoring scheme for new consultants that provides a forum for supporting them in their ongoing professional wellbeing. There is potential that the process of mentoring can improve an individual's development, and motivate and encourage them to develop the skills needed to achieve their goals, thus having an impact on ultimately improving their ability to deliver an effective patient-centred service.

  19. Health Consultation in China

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    ONE Sunday morning, I noticed some people gathered at a clearing outside a school in which my family had an apartment. Feeling curious, I joined them to find that some young dentists, wearing their white coats, were offering free consultations for people. They were selling toothbrushes and dental floss at the same time. One of my teeth was bothering me. It always felt odd when I bit something cold. I consulted with a young dentist, who was wearing a pair of glasses. He asked me many questions like when had it begun to hurt, if I felt the pain, how long it had been since I had it filled the previous time. He asked me to open my mouth and checked the tooth carefully. "You should have your

  20. The Language of the Bilingual Medical Consultation.

    Science.gov (United States)

    Harrison, Brian; And Others

    A study investigated translation problems arising in physician-patient interviews conducted in two languages with the help of an interpreter. Subjects were four adult native speakers of Gujarati, aged 42-70, whose physician interviews were videotape-recorded and translated, and the discourse was analyzed. Patients spoke in Gujarati, and the…

  1. The Process of Psychological Consultation

    Science.gov (United States)

    Nolan, Anna; Moreland, Neil

    2014-01-01

    Consultation is a key means of service delivery in many psychological services. However, the "process" of consultation is little explored in Educational Psychology literature, particularly in the United Kingdom (UK). This paper focuses on a small-scale qualitative research study of psychological consultation provided by educational…

  2. Management Consulting: Planning, Entry, Performance.

    Science.gov (United States)

    Cosier, Richard A.; Dalton, Dan R.

    1993-01-01

    Contends that counseling has much in common with organizational consulting. Provides overview of consulting practices that counselors might find useful should they decide to investigate organizational consulting. Includes aspects of market research, gauging competition, and target markets. Considers promotion, networking, and elements of…

  3. Effect of computer use in the consultation on the delivery of care.

    OpenAIRE

    Brownbridge, G; Evans, A.; Wall, T

    1985-01-01

    The effects of the use of a computer on the delivery of care in consultations in general practice were examined. In this trial a computer system provided for the review and update of patients' medical histories, notes on doctor-patient contacts, and information on repeat prescribing. Thirty consultations in which the computer system was used and 30 consultations in which no computer was used were matched individually for the doctor consulted, the sex and age of the patient, and the presenting...

  4. [Analysis of the state-of-the-art of consulting medical care to patients with glucocorticoid-induced osteoporosis or its risk according to the data of a questionnaire survey (GLUCOST study)].

    Science.gov (United States)

    Baranova, I A; Ershova, O B; Anaev, E Kh; Anokhina, T N; Anoshenkova, О N; Batyn, S Z; Belyaeva, E A; Bolshakova, T Yu; Volkorezov, I A; Eliseeva, L N; Kashnazarova, E V; Kinyaikin, M F; Kirpikova, M N; Klyuchnikova, E P; Korolev, M A; Kuneevskaya, I V; Masneva, L V; Muradyants, A A; Otteva, E N; Petrachkova, T N; Peshekhonova, L K; Povzun, A S; Raskina, T A; Smirnova, M L; Toroptsova, N V; Khasanova, R B; Shamsutdinova, N G; Shaporova, N L; Shitova, N S; Shkireeva, S Yu; Shostak, N A; Lesnyak, O M

    2015-01-01

    To analyze the state-of-the-art of consulting medical care to Russian patients with glucocorticoid-induced osteoporosis (GCOP) or its risk. This GLUCOST study was organized and conducted by the Russian Association of Osteoporosis. A total of 1129 patients with chronic inflammatory diseases, who had been taking oral glucocorticosteroids (OGCSs) a long time (3 months or more), were examined. The patients filled out an anonymous questionnaire on their own. Whether the measures taken to diagnose, prevent, and treat GCOP complied with the main points of Russian clinical guidelines was assessed. 61.8% of the patients knew that the long-term treatment of GCOP might cause osteoporosis. 48.1% of the respondents confirmed the results of bone densitometry; 78.1% of the patients reported that they had been prescribed calcium and vitamin D supplements by their physician, but their regular intake was confirmed by only 43.4%; 25.4% of the patients had sustained one low-energy fracture or more. Treatment for GCOP was prescribed for 50.8% of the patients at high risk for fractures, but was actually received by 40.2%. Therapeutic and diagnostic measures were implemented in men less frequently than in women. When the patient was aware of GCOP, the probability that he/she would take calcium and vitamin D supplements rose 2.7-fold (95% Cl; 2.1 to 3.5; p = 0.001) and that he/she would follow treatment recommendations did 3.5-fold (95% Cl; 2.3 to 5.3; p = 0.001). Bone densitometry increased the prescription rate for antiosteoporotic medication and patient compliance. According to the data of Russia's large-scale GLUCOST survey, every four patients with chronic inflammatory disease who are on long-term OGCS therapy have one low-energy fracture or more. Due to inadequate counseling, the patients are little aware of their health and do not get the care required to prevent the disease. Less than 50% of patients who have GCOP and a high risk for fractures undergo examination and necessary

  5. The transition to hospital consultant: Denmark and the Netherlands compared on preparedness for practice, perceived intensity and contextual factors

    NARCIS (Netherlands)

    Westerman, M.; Teunissen, P.W.; Jorgensen, R.L.; Fokkema, J.P.; Siegert, C.E.; Vleuten, C.P.M. van der; Scherpbier, A.J.J.A.; Ringsted, C.; Scheele, F.

    2013-01-01

    Introduction: Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and

  6. The transition to hospital consultant and the influence of preparedness, social support, and perception: A structural equation modelling approach

    NARCIS (Netherlands)

    Westerman, M.; Teunissen, P.W.; Fokkema, J.P.; Vleuten, C.P.M. van der; Scherpbier, A.J.J.A.; Siegert, C.E.; Scheele, F.

    2013-01-01

    BACKGROUND: Insight into the transition from specialist registrar to hospital consultant is needed to better align specialty training with starting as a consultant and to facilitate this transition. AIMS: This study investigates whether preparedness regarding medical and generic competencies, percei

  7. Medical procedures in the event of nuclear power plant accidents. Guidelines for: Medical consultants for emergency response commander; physicians in emergency care centres; physicians in outpatient and inpatient care

    Energy Technology Data Exchange (ETDEWEB)

    Genkel, Simone (ed.)

    2008-07-01

    The author of the contribution under consideration reports on medical procedures in the event of nuclear power plant accidents. This contribution consists of the following sections: protective measures, tasks of radiation protection physicians, emergency care centres. It has been pointed out that differentiation of the hospitals is acquired which accept radiation accident patients. However, only a small number of hospitals will be able to professionally treat patients with suspected gastrointestinal or pronounced (muco)cutaneous type of hospitals with haemotological-oncological departments. Thus they should be able to treat patients who have been exposed to radiation doses between 1 and 6 Gy without any difficulties. Even larger is the number of hospitals which can accept patients who were exposed to a radiation dose of less than 1 Gy, but suffer from other complicating diseases (injuries, general diseases).

  8. Consulting in Electronic Commerce

    Directory of Open Access Journals (Sweden)

    Florentina Loredana Tache

    2010-10-01

    Full Text Available Economic development of electronic services provide advice and many agents of existingreferral systems to recommend and provide products, information and customized views of thecommunity through a personalized interaction in real time. Distributed systems of autonomous agentsare becoming increasingly important in electronic comet because the basic decisions of agents adviceon trust and reputation are taken in a similar way human society. If these decisions will be as a realconsumer protection, when new aspects of online consumer legislation will become usefulinformation in advice and consulting of electronic commerce.

  9. Exploring accountability of clinical ethics consultants: practice and training implications.

    Science.gov (United States)

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

    Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

  10. How does an increase in undergraduate teaching load affect GP teacher motivation? A grounded theory study using data from a new medical school.

    Science.gov (United States)

    Harding, Alex; Sweeney, Grace

    2013-07-01

    The opening of a new medical school is a cause for celebration. Starting with a clean slate often gives the opportunity to adopt more modern teaching practices. However, encouraging large numbers of clinicians to start teaching and to adopt these new methods brings its own set of challenges. During the expansion phase of a new medical school, it was often noted that new teachers seemed to have considerable difficulties, and often expressed these as negativity towards student placements. This did not chime with much of the work from established schools, which seemed to evaluate expansion of teaching more positively. We wanted to better understand the issues involved. Semi-structured interviews were conducted involving GPs who had received medical students over the first four years of a newly established medical school. The aims were to assess the impact of the students on the new teachers, and to try to better understand why some teachers were experiencing difficulties. We collected qualitative and quantitative data at the interviews. The qualitative data were analysed using grounded theory which aims to link emerging themes together. The findings suggest that as the quantity of teaching medical students increases, the enjoyment and commitment to teaching may decrease. Concerns over the administration of teaching may begin to predominate. Two factors may help to reduce this: 1 Adequate investment in manpower and premises to reduce time and space constraints on teaching. 2 Practices considering themselves as teaching practices where education is a part of the practice identity.

  11. Longitudinal training and assessing consultation competence, a role for self reflection on performance

    NARCIS (Netherlands)

    Hegge, H.H.; Slaets, J.J.; Cohen-Schotanus, J.

    2012-01-01

    Medical consultation (patient-doctor encounter), consisting of history taking, physical examination and treatment, is the starting point of any contact between doctor and patient. Learning to conduct a consultation is a complex skill. Both communicative and medical contents need to be applied and in

  12. Longitudinal training and assessing consultation competence, a role for self reflection on performance

    NARCIS (Netherlands)

    Hegge, H.H.; Slaets, J.J.; Cohen-Schotanus, J.

    2012-01-01

    Medical consultation (patient-doctor encounter), consisting of history taking, physical examination and treatment, is the starting point of any contact between doctor and patient. Learning to conduct a consultation is a complex skill. Both communicative and medical contents need to be applied and in

  13. Multilocation teleradiology system for emergency triage consultation

    Science.gov (United States)

    Herron, John M.; Yonas, Howard

    1996-05-01

    A remote consultation system is available at the University of Pittsburgh Medical Center (UPMC) which links four outlying hospitals in Western Pennsylvania and Eastern Ohio. This system has the potential to improve short and long term clinical outcomes and to reduce overall medical care cost by establishing improved emergency triage capability. An EMED, Inc. teleradiology system permits rapid, high-quality transfer of digitized film and CT images from the remote sites to the tertiary care center (UPMC). The images are sent over dial-on- demand ISDN and SW56 lines from the remote hospitals to a central server where they are transmitted to a dual 2K monitor workstation in the Emergency Department, thirteen Eastman Kodak PDS workstations within UPMC, and to three physician homes. Transmission to a workstation at each of the physician homes over ISDN lines enables `after hours' consultation. The radiographic images along with voice and fax communications provide a technique where physicians in outlying hospitals will be able to consult with specialists at any time. A study is in progress to evaluate the effectiveness of this system in terms of perception of utility and its potential to improve emergency triage capability, as well as selection of the appropriate transportation mode (helicopter versus ambulance).

  14. Applying research to practice: generalist and specialist (visual ergonomics) consultancy.

    Science.gov (United States)

    Long, Jennifer; Long, Airdrie

    2012-01-01

    Ergonomics is a holistic discipline encompassing a wide range of special interest groups. The role of an ergonomics consultant is to provide integrated solutions to improve comfort, safety and productivity. In Australia, there are two types of consultants--generalists and specialists. Both have training in ergonomics but specialist knowledge may be the result of previous education or work experience. This paper presents three projects illustrating generalist and specialist (visual ergonomics) consultancy: development of a vision screening protocol, solving visual discomfort in an office environment and solving postural discomfort in heavy industry. These case studies demonstrate how multiple ergonomics consultants may work together to solve ergonomics problems. It also describes some of the challenges for consultants, for those engaging their services and for the ergonomics profession, e.g. recognizing the boundaries of expertise, sharing information with business competitors, the costs-benefits of engaging multiple consultants and the risk of fragmentation of ergonomics knowledge and solutions. Since ergonomics problems are often multifaceted, ergonomics consultants should have a solid grounding in all domains of ergonomics, even if they ultimately only practice in one specialty or domain. This will benefit the profession and ensure that ergonomics remains a holistic discipline.

  15. Epistemics in audiological consultations

    DEFF Research Database (Denmark)

    Egbert, Maria

    ' subjective descriptions of hearing experiences in different environments. In these consultations, the institutional conceptualization of hearing (and thus of hearing loss) is that of an objectively measurable functioning of the ear, categorized in an audiogram by decibels and hertz. In contrast, persons......, broad, and metaphorical. Compared to visual impairment, describing hearing seems to be more difficult, and frequently, persons with hearing impairment resort to visual metaphors. A CA examination of conversational order in the areas of turn-taking, sequence, repair, topic, multimodality, and linguistic...... at the micro-level of direct healthcare encounters to the macro-level and globel problems of the impact of untreated hearing loss. The social repercussions are stigmatization, miscommunication, loss of work, social isolation, depression, and suicide (Carmen 2001). The financial loss per person dropping out...

  16. Responsive Systems Consultation: A Model for Conjoint Consultation Preliminary Results.

    Science.gov (United States)

    Prasad-Gaur, Archna; And Others

    Responsive Systems Consultation (RSC) is an approach for enhancing children's developmental outcomes and involves a psychological or educational consultant working jointly with a child's parents and teachers. The impact of the RSC on parent and teacher consultees' attitudes toward home-school collaboration and their evaluation of the consultation…

  17. Educating Consultants for Multicultural Practice of Consultee-Centered Consultation

    Science.gov (United States)

    Ingraham, Colette L.

    2017-01-01

    Literature about educating consultants with knowledge, skills, and dispositions to work effectively within culturally and linguistically diverse schools is scarce. Research suggests that additional attention is needed on the preparation of consultants to practice with multicultural competence. This article reviews theories and research and…

  18. Clinical Informatics Consult Service Positively Affects Some Clinical Decisions in the ICU. A Review of: Mulvaney, Shelagh A., Leonard Bickman, Nunzia B. Giuse, Warren E. Lambert, Nila A. Sathe, and Rebecca N. Jerome." A Randomized Effectiveness Trial of a Clinical Informatics Consult Service: Impact on Evidence-based Decision-making and Knowledge Implementation." Journal of the American Medical Informatics Association 15.2 (2008: 203-11.

    Directory of Open Access Journals (Sweden)

    Jennifer Kelson

    2009-06-01

    Full Text Available Objective – To determine whether the provision of synthesized research evidence provided by the Clinical Informatics Consult Service (CICS affects the clinical decision-making of clinicians working in intensive care units (ICUs.Design – Non-blinded randomized control effectiveness trial.Setting – ICUs in United States-based 658 bed university hospital providing tertiary care for adults and children.Subjects – Clinical staff working within one of four ICUs who submitted a request for clinical information during the study period.Methods – Valid requests submitted by clinical staff from the four clinical ICUs (medical, paediatric, trauma, or neonatal were randomly allocated to receive information from the CICS (CICS provided or no information (no CICS provided. Pre-consult forms, completed at the time of the request, examined reasons for the request and the clinical actions clinicians thought might be influenced by the search results. Requestors could opt out of the no CICS provided group either before or after the randomization of their request. Responses to requests, supplied within 0.5 to 7 days as agreed with the requestor, included a search strategy and bibliographic references, a targeted list of full-text articles, and a written synthesis and critique of the relevant research. Clinicians within both groups were free to conduct their own searches and reviews. An online evaluation form, emailed to recipients, was used to assess the impact of the information supplied. The evaluation form asked clinicians to record the time spent on their own searches, sources of information consulted including colleagues, the immediate and future impact of the information provided (either from the CICS or their own searches, what influence the information had on their clinical actions, whether there were any barriers to using the information, and quality and overall satisfaction with the results provided by the CICS. Data was analyzed according to the

  19. Information from the MEDICAL SERVICE

    CERN Multimedia

    Safety Commission

    2008-01-01

    The CERN infirmary (ground floor, Building 57) is open from 8.00 a.m. to 5.30 p.m. every working day. It is open for emergencies only between 12.30 and 1.30 p.m., to allow the nurses to take their lunch breaks. The Medical Service only gives first-level medical treatment and under no circumstances can it take the place of your family doctor. A list of doctors, dentists and other health professionals in the Pay de Gex and Meyrin can be consulted on the Medical Service’s regularly updated web page: http://sc-me.web.cern.ch/sc-me/ In the event of an emergency on the CERN site, the first number to call is 74444.

  20. Development of a teledermatopathology consultation system using virtual slides

    Directory of Open Access Journals (Sweden)

    Nakayama Ikunori

    2012-12-01

    teledermatopathological consultation system using virtual slides, and investigated the usefulness of the system. The results demonstrate that our system can be a useful tool for international medical work, and we anticipate its wider application in the future. Virtual slides The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1902376044831574

  1. Advanced training of tax consultants

    Directory of Open Access Journals (Sweden)

    Adigamova Farida F.

    2016-01-01

    Full Text Available The purpose of the research is to review and analyze the data on the necessity to provide an educational environment for training and advanced training of tax consultants in Russia. The article considers the types of tax consulting, the historical background of training financiers in Russia, as well as identifies conditions determining the significance of tax consulting. The research establishes the connection between the negative attitude to tax payment and tax evasion. The advanced training of tax consultants should be a continuous process as they need to take into account both external and internal taxpayers risks associated with the development of law and law-enforcement practice. Obviously, the training of tax consultants should take into account the experience of developed foreign countries, such as Germany, Austria, Czech Republic, Slovakia and other European countries as well. In Russia, it is necessary to open educational institutions, which will not only be involved in the certification of tax consultants, but also provide training courses. These courses should contribute to constant increase of tax consultants knowledge, consider the tax treatment of economic activities, as well changes in the legislation, economics, finance, accounting, manufacturing processes, which will improve the quality of services provided by tax consultants.

  2. New Consultant Joins Occupational Health Services’ Team | Poster

    Science.gov (United States)

    One of Occupational Health Services’ (OHS') most valuable resources is new medical consultant Anusha Belani, M.D., chief of epidemiology at Frederick Memorial Hospital (FMH). Belani graduated from the University of Delhi and received her medical degree from Lady Hardinge Medical College in 1979. She is currently the only physician in Frederick County who specializes in infectious diseases. After completing her residency at Sinai Hospital, Belani established her own practice in Frederick in January of 1987.

  3. Pharmaceutical consultation in UAE community pharmacies

    Directory of Open Access Journals (Sweden)

    N M Hamoudi

    2011-01-01

    Full Text Available In recent years, the focus of pharmacists as traditional drug dispensers has shifted to more active and participative role in risk assessment, risk management, and other medication related consultation activities. Pharmacy profession is evolving steadily in the United Arab Emirates (UAE. Pharmacists in UAE are so much occupied in their administrative and managerial duties that dispensing is mostly attended to by pharmacy technicians. Pharmacist-led patient counseling is limited to the dosage and frequency of medications and rarely adverse reactions and drug interactions with other medications. Therefore we decided to perform quantitative questionnaires study to explore the role of pharmacist in patient counseling in UAE, the evaluation of pharmacist′s opinion on patient counseling and the potential determinants of personal consultation. Results show the frequency and nature of inquiries received by pharmacist. Five to twenty inquires per month are received from patient, most of them related to drug prescription and dose recommendation. Thirty nine percent of pharmacists received inquiries from doctors, most of them related to the dose and mode of action. Ninty two percent of the pharmacists agreed that patient counseling is their professional responsibility. About 82% of pharmacists agreed that counseling will increase their sales and enhance the reputation of their pharmacies. Seventy percent of pharmacists mentioned that they need to undergo training for effective counseling while 46% of pharmacists felt that more staff in the pharmacies would have a positive influence on patient compliance to medication therapies and patient safety. The potential determinants of personal consultation show that 52% of participants trusted pharmacist and 55% considered the pharmacist as a friend. Forty eight percent of participants visited the pharmacy for medical recommendation while 30% for drug compounding, 72% agreed that pharmacist conducts full

  4. Pharmaceutical Consultation in UAE Community Pharmacies.

    Science.gov (United States)

    Hamoudi, N M; Shirwaikar, A A; Ali, H S; Al Ayoubi, E I

    2011-07-01

    In recent years, the focus of pharmacists as traditional drug dispensers has shifted to more active and participative role in risk assessment, risk management, and other medication related consultation activities. Pharmacy profession is evolving steadily in the United Arab Emirates (UAE). Pharmacists in UAE are so much occupied in their administrative and managerial duties that dispensing is mostly attended to by pharmacy technicians. Pharmacist-led patient counseling is limited to the dosage and frequency of medications and rarely adverse reactions and drug interactions with other medications. Therefore we decided to perform quantitative questionnaires study to explore the role of pharmacist in patient counseling in UAE, the evaluation of pharmacist's opinion on patient counseling and the potential determinants of personal consultation. Results show the frequency and nature of inquiries received by pharmacist. Five to twenty inquires per month are received from patient, most of them related to drug prescription and dose recommendation. Thirty nine percent of pharmacists received inquiries from doctors, most of them related to the dose and mode of action. Ninty two percent of the pharmacists agreed that patient counseling is their professional responsibility. About 82% of pharmacists agreed that counseling will increase their sales and enhance the reputation of their pharmacies. Seventy percent of pharmacists mentioned that they need to undergo training for effective counseling while 46% of pharmacists felt that more staff in the pharmacies would have a positive influence on patient compliance to medication therapies and patient safety. The potential determinants of personal consultation show that 52% of participants trusted pharmacist and 55% considered the pharmacist as a friend. Forty eight percent of participants visited the pharmacy for medical recommendation while 30% for drug compounding, 72% agreed that pharmacist conducts full instruction while 31% agreed

  5. The Hannover Consultation Liaison model: some empirical findings.

    Science.gov (United States)

    Freyberger, H; Künsebeck, H W; Lempa, W; Avenarius, H J; Liedtke, R; Plassman, R; Nordmeyer, J

    1985-01-01

    Starting from the definitions concerning the concepts 'Liaison medicine' and 'Consultative Psychiatry' we begin with remarks with regard to the Consultation Liaison-Situation in West Germany on the basis of the key-words 'Brief history', 'Independent university units with regard to Psychotherapy and Psychosomatics as well as the connected organization' and 'Teaching procedures'. Following it the Hannover Consultation Liaison model is presented particularly with regard to both the psychosomatic inpatient ward including the functional organization and psychotherapeutic processes as well as the so-called 'Innere Ambulanz' which includes the consultation liaison services in the clinico-medical departments outside Psychiatry and Psychosomatics. Within the 'Innere Ambulanz', which is closely connected to our psychosomatic inpatient ward, the consultation liaison activities and the resulting supportive psychotherapeutic strategies are performed by student auxiliary therapists who are interested in completing their 4-5 months internship-time in our department. We describe both the three supportive psychotherapeutic steps, which may last months to years including subsequent dynamically psychotherapeutic strategies as well as the reactions of the auxiliary therapist function on the students. Furthermore, we may state that there exists no one more optional education procedure of graduate students than the student's confrontation with his partial self-responsibility vis-à-vis a patient who is being supportive-psychotherapeutically treated by him. Specific empirical proofs concerning our patient oriented consultation liaison activities are demonstrated on the basis of previous psychotherapeutic findings in Crohn patients. Here we are able to demonstrate the effectivity of psychotherapy in the case of the supplementarily psychotherapeutically treated patients in comparison to the patients who received medical therapy only. Finally we are able to present quantitative clinico-medical

  6. Language barriers within primary care consultations: an increasing challenge needing new solutions.

    Science.gov (United States)

    Li, Shuangyu; Pearson, David; Escott, Sarah

    2010-11-01

    International migration is an increasing global phenomenon, particularly noticeable in the UK where removing barriers to travel and residence within an expanded European Union has brought a huge increase in new arrivals. Migration has increased the number of medical consultations where language barriers occur. This paper summarises findings from a review of the literature and explores the challenges posed within these medical consultations, particularly those in primary care. It highlights limitations to current consultation models and educational interventions to improve consultations across language barriers, and suggests future solutions to those problems.

  7. Automating radiologist workflow part 1: the digital consultation.

    Science.gov (United States)

    Reiner, Bruce

    2008-10-01

    With the widespread adoption of picture archiving and communication systems and filmless imaging, ubiquitous and instantaneous access to imaging data has resulted in decreased radiologist-clinician consultations. It is therefore imperative that the radiology community develop new communication strategies to improve both the timeliness and the perceived value of the radiology report. One strategy to accomplish this goal is the creation of electronic consultation tools, which can effectively recreate radiologist workflow and the identification of key pathologic findings in an easy-to-use, well-organized, and timely fashion. This would be accomplished by recording radiologist-computer interactions using an electronic auditing tool, storing these interactions in an extensible markup language schema, which can subsequently be played back at a later point in time to recreate the radiologist consultation. This approach has the added benefits of allowing the radiologist to selectively edit content to the needs of different clinician users, index the comprehensive consultation into pathology-specific components, and perform asynchronous bidirectional consultations. This electronic consultation tool would result in the creation of context and user-specific consultation files, which can in turn be integrated with clinical data from electronic medical records.

  8. The role of consulting psychiatrists for obstetric and gynecologic inpatients.

    Science.gov (United States)

    Lin, Huang-Li; Chou, Hung-Hsueh; Liu, Chia-Yih; Hsu, Shi-Chieh; Hsiao, Mei-Chun; Juang, Yeong-Yuh

    2011-01-01

    The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.

  9. Utilização de consulta médica e hipertensão arterial sistêmica nas áreas urbanas e rurais do Brasil, segundo dados da PNAD 2008 Use of medical consultations and the occurrence of systemic arterial hypertension in urban and rural areas of Brazil, according to PNAD data 2008

    Directory of Open Access Journals (Sweden)

    Jessica Pronestino de Lima Moreira

    2011-09-01

    Full Text Available A utilização de consultas médicas é influenciada por determinantes, como necessidades de saúde e características dos serviços, que dependem se o ambiente é urbano ou rural. Objetiva-se estimar a proporção de consulta ao médico nos últimos 12 meses dos indivíduos que referiram ou não hipertensão arterial sistêmica (HAS, residentes em área urbana e rural, e analisar os padrões de utilização de consulta e associações. Trata-se de um estudo seccional, utilizando a PNAD 2008. Executaram-se regressões logísticas para obter odds ratios (OR's, brutas e ajustadas, por HAS autorreferida e situação do domicílio. Consultaram o médico 70,6% dos adultos brasileiros. Foi encontrada uma associação entre HAS e consulta ao médico de 3,63 (OR maior na área urbana. A chance de consulta ao médico foi maior entre as mulheres, os que utilizam medicamentos contínuos, os que possuem plano de saúde ou tiveram financiamento no último atendimento, os que referiram alguma morbidade ou limitação na mobilidade e entre os que referiram estado de saúde ruim, em todos os estratos. A análise multivariada modificou as associações de todas as variáveis. Diferenças nas duas áreas sugerem que políticas de acesso devem ser implantadas, com o objetivo de reduzir iniquidades.The use of medical consultations is influenced by determinants such as healthcare needs and service characteristics, which depend on whether the environment is urban or rural. The scope was to estimate the proportions of individuals attending medical consultations over the previous 12 months with and without self-reported systemic arterial hypertension (SAH living in urban and rural areas, and to analyze the patterns of consultation use and associations. This was a sectional study, using PNAD 2008. Logistic regression was performed to obtain crude and adjusted odds ratios (ORs, according to self-reported SAH and household situation. 70.6% of adult Brazilians consult

  10. A report on small team clinical ethics consultation programmes in Japan.

    Science.gov (United States)

    Fukuyama, M; Asai, A; Itai, K; Bito, S

    2008-12-01

    Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and questions about patient autonomy. In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan's first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received. Over approximately 15 months (October 2006-December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes.

  11. The role of assessment packages for diagnostic consultations

    DEFF Research Database (Denmark)

    Rossen, Camilla B; Buus, Niels; Stenager, Egon

    2015-01-01

    and content. Assessment packages are widely used in an increasing number of medical specialities; however, there is a lack of knowledge about how packaged assessment influences the interaction between doctor and patient. In this study, we investigate the final consultation in assessment packages, which......This article reports a conversation analysis of assessment package consultations. Healthcare delivery packages belong to a highly structured mode of healthcare delivery, in which specific courses of healthcare interventions related to assessment and treatment are predefined, both as to timing...... is when the final clarification of the patient's symptoms takes place. The primary data of the study were eight audio recordings of consultations, and the secondary data were ethnographic field descriptions. In most consultations, packaged assessment was a resource as it provided fast and efficient...

  12. Virtual slides: application in pulmonary pathology consultations.

    Directory of Open Access Journals (Sweden)

    Michał Wojciechowski

    2008-02-01

    Full Text Available The Virtual Slide (VS is an interactive microscope emulator that presents a complete digitized tissue section via the Internet. A successful implementation of VS has been observed for educational, research venues and quality control. VS acquisition for consultative pathology is not so common. The purpose of this study was to explore the efficacy and usability of VS in the consultative pulmonary telepathology. 20 lung tumors entered the study. The performance was programmed for 2 medical centers specialized in pulmonary pathology (beginner and advancer in telepathology. A high-quality VSs were prepared by Coolscope (Nikon, Eclipsnet VSL, Japan, and were evaluated via the Internet. The cases were reviewed for the second time with conventional light microscope. VS diagnostic accuracy and the interobserver variability were evaluated. Also the time taken by examiners to render the diagnoses and time needed to scan the microscopic slide were analyzed. Percentage concordance between original glass-slides diagnosis and diagnosis for VSs was very high. Pathologists found the download speed of VSs adequate; experience in telepathology reduced the time of VS diagnosis. VS implementation suggests advantages for teleconsulation and education but also indicate some technical limitations. This is the first Polish trial of VS implementation in telepathology consultative service.

  13. Communication strategies for a successful inpatient dermatology consultative service: a narrative review.

    Science.gov (United States)

    Afifi, Ladan; Shinkai, Kanade

    2017-03-01

    Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must develop strong relationships with primary inpatient teams requesting consults in order to provide optimal patient care. Prior studies have identified effective communication practices for inpatient consultative services. This narrative review provides a summary of effective communication practices for an inpatient dermatology consultation service organized into 5 domains: (1) features of the initial consult request; (2) best practices in responding to the initial consult; (3) effective communication of recommendations; (4) interventions to improve consultations; and (5) handling curbside consultations. Recommendations include identifying the specific reason for consult; establishing urgency; secure sharing of sensitive clinical information such as photographs; ensuring timely responses; providing clear yet brief documentation of the differential diagnosis, problem list, final diagnosis and recommendations; and limiting curbside consultations. Future studies are needed to validate effective strategies to enhance communication practices within an inpatient dermatology consultative service. ©2017 Frontline Medical Communications.

  14. The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

    Science.gov (United States)

    Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

    2017-08-01

    Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

  15. Asynchronous vascular consultation via electronic methods: A feasibility pilot.

    Science.gov (United States)

    Chittle, Melissa D; Rao, Sandhya K; Jaff, Michael R; Patel, Virendra I; Gallen, Kathleen M; Avadhani, Radhika; Ferris, Timothy G; Wasfy, Jason H

    2015-12-01

    Management of chronic disease often requires multidisciplinary clinical efforts and specialist care. With the emergence of Accountable Care Organizations (ACOs), health care systems are incentivized to evaluate methods of information exchange between generalists and specialists in order to provide value while preserving quality. Our objective was to evaluate patient and referring provider satisfaction and outcomes of asynchronous electronic consultations in vascular care in a large tertiary academic medical center. Referring providers were offered a vascular 'e-consult' option through an electronic referral management system. We conducted chart review to understand the downstream effects and surveyed patients and referring providers to assess satisfaction. From 24 March 2014 to 1 March 2015, 54 e-consults were completed. Additional testing and recommendations were made in 49/54 (90.7%) e-consults, including lower-extremity venous duplex ultrasonography with reflux testing, duplex ultrasonography of the carotid artery, computed tomography, magnetic resonance imaging, non-invasive physiology arterial studies, laboratory tests, medications, compression stockings, and sequential lymphedema compression therapy. Referring providers were compliant with recommendations in 40/49 (81.6%) of e-consults. A total of 17/54 (31.5%) patients were surveyed with a median patient satisfaction score of 13.7/15 (91.3%) (SD ± 6.4). The program was associated with high referring provider satisfaction, with 87.0% finding the e-consult very helpful and 80.0% stating it averted the need for a traditional visit. Our experience suggests that e-consults are an effective way to provide vascular care in some patients and are associated with high patient and provider satisfaction. E-consults may therefore be an efficient method of care delivery for vascular patients within an ACO.

  16. Lactation Consultants' Perceived Barriers to Providing Professional Breastfeeding Support.

    Science.gov (United States)

    Anstey, Erica H; Coulter, Martha; Jevitt, Cecilia M; Perrin, Kay M; Dabrow, Sharon; Klasko-Foster, Lynne B; Daley, Ellen M

    2017-08-01

    Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants' perceived barriers to managing early breastfeeding problems. This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother's self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.

  17. Developing a model osteoarthritis consultation: a Delphi consensus exercise

    Directory of Open Access Journals (Sweden)

    Porcheret Mark

    2013-01-01

    Full Text Available Abstract Background Osteoarthritis (OA is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems. Methods A postal Delphi consensus exercise was undertaken with two expert groups: i general practitioners (GPs with expertise in OA management and ii patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%. Results The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i assessment of chronic joint pain, ii patient’s ideas and concerns, iii exclusion of red flags, iv examination, v provision of the diagnosis and written information, vi promotion of exercise and weight loss, vii initial pain management and viii arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence. Conclusions This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.

  18. Developing a model osteoarthritis consultation: a Delphi consensus exercise.

    Science.gov (United States)

    Porcheret, Mark; Grime, Janet; Main, Chris; Dziedzic, Krysia

    2013-01-16

    Osteoarthritis (OA) is a common condition managed in general practice, but often not in line with published guidance. The ideal consultation for a patient presenting with possible OA is not known. The aim of the study was to develop the content of a model OA consultation for the assessment and treatment of older adults presenting in general practice with peripheral joint problems. A postal Delphi consensus exercise was undertaken with two expert groups: i) general practitioners (GPs) with expertise in OA management and ii) patients with experience of living with OA. An advisory group generated 61 possible consultation tasks for consideration in the consensus exercise. Expert groups were asked to consider which tasks should be included in the model OA consultation. The exercise was completed by 15 GPs and 14 patients. The level of agreement for inclusion in the model was set at 90%. The model OA consultation included 25 tasks to be undertaken during the initial consultation between a GP and a patient presenting with peripheral joint pain. The 25 tasks provide detailed advice on how the following elements of the consultation should be addressed: i) assessment of chronic joint pain, ii) patient's ideas and concerns, iii) exclusion of red flags, iv) examination, v) provision of the diagnosis and written information, vi) promotion of exercise and weight loss, vii) initial pain management and viii) arranging a follow-up appointment. Both groups prioritised a bio-medical approach to the consultation, rather than a bio-psycho-social one, suggesting a discordance between current thinking and research evidence. This study has enabled the priorities of GPs and patients to be identified for a model OA consultation. The results of this consensus study will inform the development of best practice for the management of OA in primary care and the implementation of evidence-based guidelines for OA in primary care.

  19. Functional somatic symptoms and consultation patterns in 5- to 7-year-olds

    DEFF Research Database (Denmark)

    Rask, Charlotte Ulrikka; Ørnbøl, Eva; Fink, Per Klausen

    2013-01-01

    OBJECTIVE: To investigate the frequency of and factors linked to medical consultation for functional somatic symptoms (FSS) among 5- to 7-year-old children. METHODS: We assessed 1327 children from the Copenhagen Child Cohort 2000 for FSS at ages 5 to 7 years. Register data on past health care use...... in general practice were compared between children with and those without parent-reported medical consultation for FSS at the age of 5 to 7 years: respective consulters (n = 96) and nonconsulters (n = 211) and children without FSS (n = 1019). Degree of parental worries about the child's symptoms and parent......-reported symptom characteristics and associated impacts were compared between consulters and nonconsulters. RESULTS: Among 308 children with FSS, 31.1% were consulters. Being a consulter was significantly associated with multisymptomatic presentation, parental worries about the symptoms, symptom impact...

  20. Simulated consultations: a sociolinguistic perspective

    National Research Council Canada - National Science Library

    Atkins, Sarah; Roberts, Celia; Hawthorne, Kamila; Greenhalgh, Trisha

    2016-01-01

    .... Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters--for which sociolinguistics, defined as the study of language...

  1. Beyond the ‘dyad’: a qualitative re-evaluation of the changing clinical consultation

    Science.gov (United States)

    Swinglehurst, Deborah; Roberts, Celia; Li, Shuangyu; Weber, Orest; Singy, Pascal

    2014-01-01

    Objective To identify characteristics of consultations that do not conform to the traditionally understood communication ‘dyad’, in order to highlight implications for medical education and develop a reflective ‘toolkit’ for use by medical practitioners and educators in the analysis of consultations. Design A series of interdisciplinary research workshops spanning 12 months explored the social impact of globalisation and computerisation on the clinical consultation, focusing specifically on contemporary challenges to the clinician–patient dyad. Researchers presented detailed case studies of consultations, taken from their recent research projects. Drawing on concepts from applied sociolinguistics, further analysis of selected case studies prompted the identification of key emergent themes. Setting University departments in the UK and Switzerland. Participants Six researchers with backgrounds in medicine, applied linguistics, sociolinguistics and medical education. One workshop was also attended by PhD students conducting research on healthcare interactions. Results The contemporary consultation is characterised by a multiplicity of voices. Incorporation of additional voices in the consultation creates new forms of order (and disorder) in the interaction. The roles ‘clinician’ and ‘patient’ are blurred as they become increasingly distributed between different participants. These new consultation arrangements make new demands on clinicians, which lie beyond the scope of most educational programmes for clinical communication. Conclusions The consultation is changing. Traditional consultation models that assume a ‘dyadic’ consultation do not adequately incorporate the realities of many contemporary consultations. A paradox emerges between the need to manage consultations in a ‘super-diverse’ multilingual society, while also attending to increasing requirements for standardised protocol-driven approaches to care prompted by computer use. The

  2. Beyond the 'dyad': a qualitative re-evaluation of the changing clinical consultation.

    Science.gov (United States)

    Swinglehurst, Deborah; Roberts, Celia; Li, Shuangyu; Weber, Orest; Singy, Pascal

    2014-09-29

    To identify characteristics of consultations that do not conform to the traditionally understood communication 'dyad', in order to highlight implications for medical education and develop a reflective 'toolkit' for use by medical practitioners and educators in the analysis of consultations. A series of interdisciplinary research workshops spanning 12 months explored the social impact of globalisation and computerisation on the clinical consultation, focusing specifically on contemporary challenges to the clinician-patient dyad. Researchers presented detailed case studies of consultations, taken from their recent research projects. Drawing on concepts from applied sociolinguistics, further analysis of selected case studies prompted the identification of key emergent themes. University departments in the UK and Switzerland. Six researchers with backgrounds in medicine, applied linguistics, sociolinguistics and medical education. One workshop was also attended by PhD students conducting research on healthcare interactions. The contemporary consultation is characterised by a multiplicity of voices. Incorporation of additional voices in the consultation creates new forms of order (and disorder) in the interaction. The roles 'clinician' and 'patient' are blurred as they become increasingly distributed between different participants. These new consultation arrangements make new demands on clinicians, which lie beyond the scope of most educational programmes for clinical communication. The consultation is changing. Traditional consultation models that assume a 'dyadic' consultation do not adequately incorporate the realities of many contemporary consultations. A paradox emerges between the need to manage consultations in a 'super-diverse' multilingual society, while also attending to increasing requirements for standardised protocol-driven approaches to care prompted by computer use. The tension between standardisation and flexibility requires addressing in educational

  3. Relation between a career and family life for English hospital consultants: qualitative, semistructured interview study

    Science.gov (United States)

    Dumelow, Carol; Littlejohns, Peter; Griffiths, Sîan

    2000-01-01

    Objective To explore the relation between work and family life among hospital consultants and their attitude towards the choices and constraints that influence this relation. Design Qualitative study of consultants' experiences and views based on tape recorded semistructured interviews. Setting Former South Thames health region in southeast England. Participants 202 male and female NHS hospital consultants aged between 40 to 50 years representing all hospital medical specialties. Results Three types of relation between work and family life (career dominant, segregated, and accommodating) were identified among hospital consultants. Most consultants had a segregated relation, although female consultants were more likely than male consultants to have a career dominant or an accommodating relation. Many male consultants and some female consultants expressed considerable dissatisfaction with the balance between their career and family life. A factor influencing this dissatisfaction was the perceived lack of choice to spend time on their personal or family life, because of the working practices and attitudes within hospital culture, if they wanted a successful career. Conclusions Consultants are currently fitting in with the profession rather than the profession adapting to enable doctors to have fulfilling professional and personal lives. Current government policies to increase the medical workforce and promote family friendly policies in the NHS ought to take account of the need for a fundamental change in hospital culture to enable doctors to be more involved in their personal or family life without detriment to their career progress. PMID:10827044

  4. [ICD diagnoses in university polyclinic naturopathy consultation].

    Science.gov (United States)

    Hentschel, C; Lindner, M; Brinkhaus, B; Nagel, M R; Hahn, E G; Kohnen, R

    1996-08-01

    In a special consulting office for complementary medicine, ambulatory patients interested in receiving adjuvant treatment with complementary medicine can obtain a relevant advice and critical information regarding non-evaluated therapies. Within the framework of a retrospective statistical analysis, the diagnosis documented over a period of 24 months in accordance with the 4-digit ICD code were evaluated. In particular patients with chronic and/or functional illnesses had additional treatment needs. The exponential growth in the numbers of patients during the course of the observation period illustrates the increasing importance of complementary medical measures. However, in view of the considerable political significance of the cost factor and the possible risks of the treatment, only properly evaluated complementary medical therapies should be employed.

  5. ICU Multipoint Military Pacific Consultation using Telehealth (IMMPACT)

    Science.gov (United States)

    2010-05-01

    Medical Center Department of Defense eICU Program Director in Chief eICU Director COL Joseph Pina , MD LTC Eric Crawley, MD Principal...Liaisons Steven Sellner, RN Ms. Laurie Kalleberg, CCRN - Korea LCDR Robert Krejci, CCRN - Guam eICU Intensive Care Consultants COL J Pina , MD

  6. Assessing University Nephrology Training as Preparation for Community Consultative Practice.

    Science.gov (United States)

    Muther, Richard S.; And Others

    1989-01-01

    Information about the consultative practice of nephrology in a community environment was gathered and used to speculate about improvements that could be made in the training of nephrologists in academic medical centers, based on their knowledge of such training. (Author/MLW)

  7. Changes in the remuneration system for general practitioners: effects on contact type and consultation length.

    Science.gov (United States)

    van Dijk, Christel E; Verheij, Robert A; te Brake, Hans; Spreeuwenberg, Peter; Groenewegen, Peter P; de Bakker, Dinny H

    2014-01-01

    In The Netherlands, the remuneration system for GPs changed in 2006. Before the change, GPs received a capitation fee for publicly insured patients and fee for service (FFS) for privately insured patients. In 2006, a combined system was introduced for all patients, with elements of capitation as well as FFS. This created a unique opportunity to investigate the effects of the change in the remuneration system on contact type and consultation length. Our hypothesis was that for former publicly insured patients the change would lead to an increase in the proportion of home visits, a decrease in the proportion of telephone consultations and an increase in consultation length relative to formerly privately insured patients. Data were used from electronic medical records from 36 to 58 Dutch GP practices and from 532,800 to 743,961 patient contacts between 2002 and 2008 for contact type data. For consultation length, 1,994 videotaped consultations were used from 85 GP practices in 2002 and 499 consultations from 16 GP practices in 2008. Multilevel multinomial regression analysis was used to analyse consultation type. Multilevel logistic and linear regression analyses were used to examine consultation length. Our study shows that contact type and consultation length were hardly affected by the change in remuneration system, though the proportion of home visits slightly decreased for privately insured patients compared with publicly insured patients. Declaration behaviour regarding telephone consultations did change; GP practices more consistently declared telephone consultations after 2006.

  8. Academic Development for Careers in Management Consulting

    Science.gov (United States)

    Adams, Susan M.; Zanzi, Alberto

    2004-01-01

    Explores the extent to which academic offerings are serving the consulting industry and identifies ways that academia can help. The numbers of management consulting courses, field experiences in consulting and consulting concentrations by graduate business schools were tracked over a three-year period to assess the current state of offerings. A…

  9. Communication Consulting as Persuasion: Issues and Implications.

    Science.gov (United States)

    Ross, Roseanna G.

    Focusing on the issue of the training and preparation of the communication specialist in communication consulting, an investigation of the persuasive elements in the client-consulting relationship suggests that more direct focus on consulting as persuasion can lead to more responsible and effective enactment of the role of both consultant and…

  10. EQClinic: a platform for learning communication skills in clinical consultations

    Directory of Open Access Journals (Sweden)

    Chunfeng Liu

    2016-07-01

    Full Text Available Background: Doctors’ verbal and non-verbal communication skills have an impact on patients’ health outcomes, so it is important for medical students to develop these skills. Traditional, non-verbal communication skills training can involve a tutor manually annotating a student's non-verbal behaviour during patient–doctor consultations, but this is very time-consuming. Tele-conference systems have been used in verbal communication skills training. Methods: We describe EQClinic, a system that enables verbal and non-verbal communication skills training during tele-consultations with simulated patients (SPs, with evaluation exercises promoting reflection. Students and SPs can have tele-consultations through the tele-consultation component. In this component, SPs can provide feedback to students through a thumbs-up/ thumbs-down tool and a comments box. EQClinic automatically analyses communication features in the recorded consultations, such as facial expressions, and provides graphical representations. Our 2015 pilot study investigated whether EQClinic helped students be aware of their non-verbal behaviour and improve their communication skills, and evaluated the usability of the platform. Students received automated feedback, and SP and tutor evaluations, and then completed self-assessment and reflection questionnaires. Results: Eight medical students and three SPs conducted 13 tele-consultations using EQClinic. More students paid attention to their non-verbal communication and students who were engaged in two consultations felt more confident in their second consultation. Students rated the system positively, felt comfortable using it (5.9/7, and reported that the structure (5.4/7 and information (5.8/7 were clear. This pilot provides evidence that EQClinic helps, and positively influences, medical students practise their communication skills with SPs using a tele-conference platform. Discussion: It is not easy to improve non

  11. EQClinic: a platform for learning communication skills in clinical consultations.

    Science.gov (United States)

    Liu, Chunfeng; Scott, Karen M; Lim, Renee L; Taylor, Silas; Calvo, Rafael A

    2016-01-01

    Doctors' verbal and non-verbal communication skills have an impact on patients' health outcomes, so it is important for medical students to develop these skills. Traditional, non-verbal communication skills training can involve a tutor manually annotating a student's non-verbal behaviour during patient-doctor consultations, but this is very time-consuming. Tele-conference systems have been used in verbal communication skills training. We describe EQClinic, a system that enables verbal and non-verbal communication skills training during tele-consultations with simulated patients (SPs), with evaluation exercises promoting reflection. Students and SPs can have tele-consultations through the tele-consultation component. In this component, SPs can provide feedback to students through a thumbs-up/ thumbs-down tool and a comments box. EQClinic automatically analyses communication features in the recorded consultations, such as facial expressions, and provides graphical representations. Our 2015 pilot study investigated whether EQClinic helped students be aware of their non-verbal behaviour and improve their communication skills, and evaluated the usability of the platform. Students received automated feedback, and SP and tutor evaluations, and then completed self-assessment and reflection questionnaires. Eight medical students and three SPs conducted 13 tele-consultations using EQClinic. More students paid attention to their non-verbal communication and students who were engaged in two consultations felt more confident in their second consultation. Students rated the system positively, felt comfortable using it (5.9/7), and reported that the structure (5.4/7) and information (5.8/7) were clear. This pilot provides evidence that EQClinic helps, and positively influences, medical students practise their communication skills with SPs using a tele-conference platform. It is not easy to improve non-verbal communication skills in a short time period. Further evaluation of

  12. Analysis of in-hospital consultations with the department of internal medicine.

    Science.gov (United States)

    Montero Ruiz, E; Rebollar Merino, A; García Sánchez, M; Culebras López, A; Barbero Allende, J M; López Álvarez, J

    2014-05-01

    An important but understudied activity of the departments of internal medicine (IM) is the in-hospital consultations. We analyzed the requests for in-hospital consultation with IM and the potential differences between the consultations of medical and surgical departments. This was an 8-month observational prospective study that analyzed demographic variables related to the origin of the interconsultation, comorbidity, length of stay and hospital mortality, emergency, admission-consultation request delay, appropriateness (not appropriate if another department was consulted for the same reason or if the pathology behind the consultation was that of the requesting service) and, for patients who underwent surgery, whether it was requested before or after the surgery. During the study, 215 in-hospital consultations were conducted (27 consultations/month). The mean age of the patients was 69.8 years (women, 50%). Some 30.7% were requested by medical departments and 69.3% by surgical departments. Thirteen percent of the in-hospital consultations were duplicated. The department of IM was not the appropriate department consulted in 23.3% of cases (13.0% of the cases requested consultations for the same reason with another department; in 14.3% of the cases, the pathology was that of requesting department). More in-hospital consultations were conducted on Mondays and Fridays than on Thursdays (25.1% and 23.7% versus 15.3%, respectively; p=.03). The delay between admission and the request for interconsultation was of 12.6 days. Some 90.7% of the in-hospital consultations for patients undergoing surgery were requested after the intervention. There were no differences in the characteristics of the in-hospital consultations between the medical and surgical departments. In-hospital consultations directed at IM are frequently duplicate, are not well directed at the appropriate department and their urgency is incorrectly assessed. These characteristics are similar for the

  13. Kids' Medical Dictionary

    Science.gov (United States)

    ... Tendons Word! Tinnitus Word! Tobacco Word! Tonsillectomy Word! Tonsillitis Word! Trachea Word! Tragus Word! Triggers Word! Tympanogram ... purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor. © 1995- The Nemours Foundation. All ...

  14. 13 Animal Emergencies That Should Receive Immediate Veterinary Consultation and/or Care

    Science.gov (United States)

    ... Public Health 13 Animal Emergencies that Require Immediate Veterinary Consultation and/or Care Severe bleeding or bleeding ... Map | Privacy | Terms of Use Copyright © 2017 American Veterinary Medical Association

  15. Study on the Grounding Protection of the Medical Equipment and Informationalized Equipment in the Field Rescue%野战救援医疗设备和信息化设备的接地保护研究

    Institute of Scientific and Technical Information of China (English)

    温剑; 崔晓培; 樊毫军; 侯世科

    2013-01-01

    Objective To optimize the grounding method so as to improve the performance of grounding protection of the medical equipment and informationalized equipment in the field rescue. Methods Referred to relative technical specifications and parameters of medical equipment and informationalized equipment, the grounding methods were tested and compared, and further optimized under different circumstances. Results The stability, practicality and safety of grounding protection of the medical equipment and informationalized equipment in the field rescue were improved. Conclusion It can extend the service life of the equipment and improve the safety of personnel and optimize the grounding method.%目的 优化医疗设备接地方法,提高野战条件下医疗设备和信息化设备接地保护的性能.方法 参照医疗设备和信息化设备有关技术规范和设备参数,在不同环境下进行测试对比,优化接地方法.结果 提高了野战救援医疗设备和信息化设备接地保护的稳定性、实用性和安全性.结论 优化设备接地,可提高设备的使用年限和人员的安全.

  16. Training interventions for improving telephone consultation skills in clinicians.

    Science.gov (United States)

    Vaona, Alberto; Pappas, Yannis; Grewal, Rumant S; Ajaz, Mubasshir; Majeed, Azeem; Car, Josip

    2017-01-05

    Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians' telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians. To assess the effects of training interventions for clinicians' telephone consultation skills and patient outcomes. We searched CENTRAL, MEDLINE, Embase, five other electronic databases and two trial registers up to 19 May 2016, and we handsearched references, checked citations and contacted study authors to identify additional studies and data. We considered randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies evaluating training interventions compared with any control intervention, including no intervention, for improving clinicians' telephone consultation skills with patients and their impact on patient outcomes. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias of eligible studies using standard Cochrane and EPOC guidance and the certainty of evidence using GRADE. We contacted study authors where additional information was needed. We used standard methodological procedures expected by Cochrane for data analysis. We identified one very small controlled before-after study performed in 1989: this study used a

  17. Can audio recording of outpatient consultations improve patient outcome?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    different departments: Orthopedics, Urology, Internal Medicine and Pediatrics. A total of 5,460 patients will be included from the outpatient clinics. All patients randomized to an intervention group are offered audio recording of their consultation. An Interactive Voice Response platform enables an audio......Introduction Information provided in an outpatient consultation concerns medication, diagnostic tests, treatment and rehabilitation which is crucial knowledge in regards of patient compliance, decision making and general patient satisfaction. Despite good communication skills among clinicians...... the communication is challenged by the fact that patients tend to forget or misunderstand a great deal of the information given. The primary objective of this study is to investigate the effects of providing patients with an audio recording of the consultation. Methods A randomized controlled trial involving four...

  18. Narrative and Structure in Consultation

    Science.gov (United States)

    Hadley, David

    2012-01-01

    This article explores the process of consultation to professional networks, teams, groups and individuals concerned with the mental health of children and young people in the care system, and those adopted. Frequently there are significant elements of early trauma suffered by the young people and disruption in the professional organisation. The…

  19. Gamification in a Consulting Company

    NARCIS (Netherlands)

    Blaauw, Frank; Bazylevska, L.; Aiello, M.

    2014-01-01

    Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can re

  20. Tianjin Architects & Consulting Engineers

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Tianjin Architects& Consulting Engineers (TACE), established in 1952,is the largest integrated architectural design institutein Tianjian. TACE has five A-Class certificates issued by the Ministry of Construction in areas such as engineering design, and it is rated as one of the top 100 exploration and design companies in China.

  1. Gamification in a Consulting Company

    NARCIS (Netherlands)

    Blaauw, Frank; Bazylevska, L.; Aiello, M.

    2014-01-01

    Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can re

  2. A Description of the Use of Music Therapy in Consultation-Liaison Psychiatry

    OpenAIRE

    Rafieyan, Roia; Ries, Rose

    2007-01-01

    Music therapy is gaining increasing recognition for its benefit in medical settings both for its salutary effects on physiological parameters and on psychological states associated with medical illness. This article discusses the role of a music therapist in consultation-liaison psychiatry, a specialty that provides intervention for medical and surgical patients with concomitant mental health issues.

  3. Benchmarking 2010: measuring long-term care and consultant pharmacy practice.

    Science.gov (United States)

    Martin, Caren McHenry

    2011-07-01

    The American Society of Consultant Pharmacists, with support from the pharmacy management software company QS/1, has completed its 2010 survey to determine industry standards for long-term care pharmacy operations, consultant pharmacist practice, and the use of health information technology in the long-term care setting. The report presents data collected in this annual business benchmarking survey. Examples of data include gross profit margins of long-term care/closed-door pharmacies, pharmacists' salaries, prescription payer mix, consultant pharmacist productivity and contracting, and implementation of technology solutions such as ePrescribing, electronic medication administration records, electronic medical records, and automated dispensing.

  4. Diagnoses, Requests and Timing of 503 Psychiatric Consultations in Two General Hospitals

    Directory of Open Access Journals (Sweden)

    Elahe Sahimi Izadian

    2012-01-01

    Full Text Available The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists (two full-time and two part-time. This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder (43.5%, adjustment disorder (10.9% and cognitive disorder (7.6%. In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days (range=1-90, SD=13. Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction.

  5. [The presence of a companion in the primary care consultation].

    Science.gov (United States)

    Turabián, J L; Pérez Franco, B

    2015-01-01

    The presence of an adult accompanying the patient in the consulting room is a significant fact that deserves the attention of the physician. Some types of companions and their presence in the consultation have been described and may improve communication, patient management, and participatory decision making, achieving greater patient satisfaction. Consultations with companion are generally longer, and patients accompanied are often elderly, women, less educated, and with poorer physical and mental health. But it is not known exactly what is the significance of a consultation with a companion. It may be a semiological fact to keep in mind for the family diagnosis, or it may be the risks of their presence, the influence of medication, or the importance of the doctors themselves that are the cause of the presence of a companion. Different communication skills must be achieved during the interview with the companion in the consultation, rather than with the patient alone. Copyright © 2014. Publicado por Elsevier España, S.L.U.

  6. [Teledermatology versus consultations--a comparative study of 120 consultations].

    Science.gov (United States)

    Herrmann, F E; Sönnichsen, K; Blum, A

    2005-10-01

    Dermatology fulfills the prerequisites for telemedicine. An important application of telemedicine might be the field of dermatologic consultations. In this comparative study images of skin disease were taken of 120 patients hospitalized in the University Hospitals of Tuebingen to answer the following questions: (1) are the preconditions in daily routine given for teledermatology, (2) is there adequate agreement between the diagnoses reached in dermatologic consultations and with teledermatology, and (3) can the images be utilized for teaching purposes. Patient acceptance was very good and the images captured with a digital camera were easily obtained. The results of intraobserver analysis for the two teledermatologists without any knowledge of the patients' history were 70.2% and 46.4%, respectively, and with knowledge of the history 76.6% and 64.3%. The results of interobserver analysis without any knowledge of the patients' history were 46.4% and 57.2% and with knowledge of the history 64.3% and 66%, respectively. With the reduction of the image quality, reduced reliability of the diagnoses was observed. Seven of ten images could be used for teaching purposes. It was demonstrated that in dermatology telemedicine is applicable in many, but not in all patients who are referred for dermatologic consultations.

  7. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    OpenAIRE

    Sporer, Scott M.; Bernard R. Bach, Jr

    2009-01-01

    DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Sc...

  8. Use of Pharmacist Consultations for Nonprescription Laxatives in Japan: An Online Survey.

    Science.gov (United States)

    Shibata, Keita; Matsumoto, Arisa; Nakagawa, Ayumi; Akagawa, Keiko; Nakamura, Akihiro; Yamamoto, Toshinori; Kurata, Naomi

    2016-01-01

    Community pharmacies in Japan have long been advocated as effective sources of nonprescription medicines and health-related advice. Consumers sometimes self-treat symptoms of minor illnesses without consulting a pharmacist because the benefits of such consultations are not adequately recognized. The aim of this study was to investigate the use and impact of pharmacist consultations before purchase of nonprescription laxatives. An online survey was conducted July 14-22, 2012 with 500 respondents (250 men, 250 women), ranging 20-60 years old. All participants had purchased nonprescription laxatives for constipation within the past year. Stratified analysis was used to compare responses in groups that had and had not consulted a pharmacist before purchase. Consulting a pharmacist appears to improve consumers' awareness and makes them more likely to use appropriate medication. Those who consulted a pharmacist were better able to identify side effects and take appropriate action than the group that did not consult the pharmacist. Those who consulted a pharmacist were also significantly more likely to say that they would consult a pharmacist in the future. These results indicate that it is important for consumers to be able to consult with pharmacists, to improve consumers' awareness of side effects and to self-medicate appropriately, and hence improve their quality of life. Pharmacists in community pharmacy could be more active in health promotion campaigns, such as drug safety, campaigns, to raise their public profile. Increased public awareness of what pharmacists in community pharmacy do will make it easier for patients to consult with them.

  9. Core Competencies for Training Effective School Consultants

    Science.gov (United States)

    Burkhouse, Katie Lynn Sutton

    2012-01-01

    The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…

  10. Core Competencies for Training Effective School Consultants

    Science.gov (United States)

    Burkhouse, Katie Lynn Sutton

    2012-01-01

    The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…

  11. Special Education Teacher Consultant: Idealism versus Realism.

    Science.gov (United States)

    Haight, Sherrel Lee

    1984-01-01

    A review of literature on topics of teacher consultant roles, cross-categorical services, approval criteria, and caseloads suggests the position of teacher consultant as it is being implemented may be untenable. There is a critical lack of role definition at state and local levels and a dearth of professional preparation in consultation skills.…

  12. Development and implementation of a proactive geriatrics consultation model in collaboration with hospitalists.

    Science.gov (United States)

    Sennour, Youcef; Counsell, Steven R; Jones, Jerrlyn; Weiner, Michael

    2009-11-01

    Acutely ill hospitalized older adults often experience a decline in function that may be preventable using a proactive, interdisciplinary, patient-centered approach. Hospitalists are treating an increasing number of these patients. A collaborative geriatrics consultation model to prevent functional decline and improve care for older patients with geriatrics syndromes was developed and implemented in partnership with a large hospitalist group in a community teaching hospital. A team of a geriatrician and a geriatrics nurse practitioner led the new consultation service. The team assisted with identifying cases, provided consultation early in the hospital stay, focused its evaluation on functional and psychosocial issues, and assisted in clinical management to optimize implementation of recommendations. In the first 4 years, the consultation service conducted 1,538 consultations in patients with a mean age of 81 (range 56-103). The most frequent geriatrics diagnoses were gait instability, delirium, and depression; recommendations usually included consulting physical therapy, increasing activity, and changing medications. The number of referrals and referring physicians grew steadily each year. Twenty-eight of 34 (82%) of the referring hospitalists completed a Web-based satisfaction questionnaire. All responding hospitalists agreed that proactive geriatrics consultation helped them provide better care; 96% rated the service as excellent. Analysis of hospital administrative data revealed a lower length of stay index and lower hospital costs in patients receiving a geriatrics consultation. The Proactive Geriatrics Consultation Service represents a promising model of collaboration between hospitalists and geriatricians for improving care of hospitalized older adults.

  13. Telemedicine for clinical management of diabetes - a process analysis of video consultations.

    Science.gov (United States)

    Fatehi, Farhad; Gray, Leonard C; Russell, Anthony W

    2013-10-01

    We analysed 56 video consultations provided in a 5-month period by two endocrinologists from the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane. The patients were suffering from type 1 or type 2 diabetes, and 41% of them had at least one diabetic complication. Their mean age was 51 years and 45% were female. The consultations were provided to ten cities located 210-1800 km from Brisbane. A questionnaire was developed for analysing the video visits. It comprised 26 questions, arranged in six sections: (1) Patient characteristics, (2) Reason for referral, (3) Procedures and findings, (4) Recommendations, (5) Telehealth logistics, (6) Consultant's opinion. In 66% of consultations a nurse accompanied the patient. The specialist requested the nurse to perform a physical examination in 18% of these cases. No change in medications was made in 36% of the consultations. The most frequent recommendations were requesting laboratory tests (75%), insulin dose adjustments (39%) and referrals to an allied health professional (13%). Out of 56 consultations, the specialists indicated the need to perform a physical examination for 12 patients that was not possible remotely. However, they requested an in-person (face-to-face) visit for three patients. Nevertheless they believed that in 34% of the cases they could have made a better decision if the consultation had been in-person. Video consultation can substitute for a large proportion of in-person specialist consultations for people with diabetes who are referred to endocrinology specialists.

  14. [Operational availability of ground-based emergency medical services in Rheinland-Palatinate: state-wide web-based system for collation, display and analysis].

    Science.gov (United States)

    Luiz, T; van Lengen, R H; Wickenkamp, A; Kranz, T; Madler, C

    2011-05-01

    A growing number of reports have been published in Germany related to problems with the operational readiness of mobile emergency physician services, although no systematic analyses have yet been presented. However, such investigations form the prerequisite for the deployment of countermeasures. Rhineland-Palatinate (4,060,000 inhabitants, 7,753 mi(2)) is a typical territorial state in the southwest of Germany with extensive wooded areas covering 42% of the state and only few metropolitan areas. These basic conditions represent a challenge to the provision of state-wide emergency medical services (EMS). On behalf of the Ministry of the Interior a web-based platform for the collation, display and analysis of the operational readiness of all 68 ground-based physician-staffed emergency units within the state was developed. Of these units 61 are affiliated to hospitals and 7 units to medical practices and 89,000 emergency missions are carried out annually. Within the study period (April 2009-March 2010) 56 of the 68 units (82.4%) reported 1 or more periods of unavailability of operational readiness. In total 2,613 periods of temporary unavailability were documented with a mean duration of 8.9 h. The mean unavailability of operational readiness was 3.9% for the whole state, 6.2% for the northern and 1.6% for the southern EMS districts. In 7 of the units (10.3%) the degree of unavailability exceeded 5% and in 8 units (11.7%) it exceeded 10%. Two thirds of all suspended services were the result of shortages of emergency physicians, with considerably higher deficits at bases affiliated with hospitals of lower levels of care or in rural regions. This tool enables the large-scale collation and analysis of the operational readiness of physician-based ambulance services. Currently the state does not suffer from a general lack of emergency physicians. However, rural areas as well as bases affiliated with small hospitals show a considerable deficit in operational readiness

  15. Patients' perspectives on antidepressant treatment in consultations with physicians.

    Science.gov (United States)

    Fosgerau, Christina Fogtmann; Davidsen, Annette Sofie

    2014-05-01

    Patient perspectives on antidepressant treatment and physician attention, and responses toward these in consultations with patients diagnosed with depression, are rarely studied. We analyzed video-recorded consultations with general practitioners (GPs) and psychiatrists. We used conversation analysis and systemic functional linguistics and found that the perspectives patients expressed related to the possibility of achieving, and the inability to retain, a sense of agency. Patients also presented indirect expressions of shame and expressions suggesting alienation toward medical treatment. GPs attended to patient perspectives by talking about medication indirectly. When patients expressed their perspectives, GPs responded by being nonauthoritative but also without prompting patients to elaborate on their reflections. Psychiatrists responded authoritatively and never urged patients to reflect on their perspectives. Shared decision making did not take place because physicians did not explore patients' perspectives in depth or offer their expertise by taking these perspectives into consideration.

  16. Assessment on nursing serviceat hospital external consulting rooms

    Directory of Open Access Journals (Sweden)

    Mª Dolores Poyatos Ruiz

    2013-05-01

    Full Text Available The social needs and requests change constantly, so that health care is evolving to a more focused on the users, in order to meet users´ needs and expectations of those who are going to get our assistance. Aim: We have developed a research to evaluate the quality of the assistance received by the patientst in their first encounter in the hospital external consulting rooms of traumathology at Santa Bárbara Hospital, letting us know about the patient´s satisfaction after the consulting has finished. Material and method: A transverse descriptive study on the traumathology consulting room of Santa Bárbara Hospital in Puertollano was developed for two months. The research is formed by the patients who attend this consulting room for their first time. A self made multiple choice questionnaire, which was designe by experts, and patients were asked to answer it once their first consulting at traumathology service had finished. Results: 95.6% of the patients considered as good or very good the nursing kindness (confidence/reliabitity when seeing them; 93.5% of them considered as good or very good the information given to them and 90.6% of them considered as good or very good the medical explanations they got. We also noticed a significant statistical difference among nursing kindness (confidence/reliabitity, enough consultation time and explanations received, with regard to the variant high resolution. Conclusions: The study reveals that more than 90% of the interviewed people considered as good or very good the clinical assistance and service given. The research has allowed us to know the areas that we can work on and improve.

  17. Optimizing education on the inpatient dermatology consultative service.

    Science.gov (United States)

    Afifi, Ladan; Shinkai, Kanade

    2017-03-01

    A consultative dermatology service plays an important role in patient care and education in the hospital setting. Optimizing education in balance with high-quality dermatology consultative services is both a challenge and an opportunity for dermatology consultation teams. There is an emergence of new information about how dermatology can best be taught in the hospital, much of which relies on principles of workplace learning as well as the science of how learning and teaching best happen in work settings. These best practices are summarized in this narrative review with integrated discussion of concepts from outpatient dermatology education and lessons learned from other inpatient teaching models. In addition, consultative dermatology curricula should utilize a blended curriculum model comprised of patient care and active learning and self-study modalities. Specific educational methods will discuss 2 strategies: (1) direct patient-care activities (ie, bedside teaching rounds) and (2) nonpatient care activities (ie, case presentations, didactic sessions, online modules, and reading lists). ©2017 Frontline Medical Communications.

  18. The transition to hospital consultant: Denmark and the Netherlands compared on preparedness for practice, perceived intensity and contextual factors

    NARCIS (Netherlands)

    Westerman, M.; Teunissen, P.W.; Jorgensen, R.L.; Fokkema, J.P.; Siegert, C.E.; Vleuten, C.P.M. van der; Scherpbier, A.J.J.A.; Ringsted, C.; Scheele, F.

    2013-01-01

    Introduction: Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and g

  19. AN ASSESSMENT OF PERSONALITY ASPECTS OF THE STUDENTS OF TEHRAN UNIVERSITY OF MEDICAL SCIENCES

    Directory of Open Access Journals (Sweden)

    B. Nikpour

    1993-12-01

    Full Text Available In this study a base-scale is prepared for the evaluation of the personality grounds of the Tehran University of Medical Science students. Such a scoring scale may be useful to help the medical science students in career development, psychosocial consultations, and appropriate supportive care plans. A sample of 205 female and male students resident in dormitories were evaluated using “Bernreuter” personality questionnaires and computer programs prepared in this center. The percentiles of each scale is scored and represented in a systematic framework. Considering the normal distribution of the results using their means and standard deviations, the important percentages in each scale is tabulated.

  20. Nursing consultation and arterial hypertension in the Family Health Strategy: an instrument proposal

    OpenAIRE

    Larissa Codogno; Vanessa Pellegrino Toledo; Érika Christiane Marocco Duran

    2012-01-01

    This study aimed to elaborate an instrument for nursing consultations for hypertensive patients attended in the Family Health Strategy, based on Horta’s model. The instrument covers identification data, medical history, physical examination, diagnosis, expected results, prescription and nursing evolution. An instrument to guide nursing consultations with hypertensive patients allows the identification of individual and social variables that influence the evolution of hypertension, contributin...

  1. Lost in translation: using bilingual simulated patients to improve consulting across language barriers.

    Science.gov (United States)

    Escott, Sarah; Lucas, Beverley; Pearson, David

    2009-03-01

    In the light of rapid demographic change and increased globalisation of health, ways to consult effectively across language barriers are increasingly important. This article describes the development, organisation and evaluation of a UK workshop designed to develop the skills of undergraduate medical students consulting with patients with limited English proficiency, using specially recruited and trained bilingual simulated patients. The authors discuss the advantages and areas for development of the approach, before considering possible future developments.

  2. Meeting the non-clinical education and training needs of new consultants

    OpenAIRE

    Higgins, R; Gallen, D; Whiteman, S

    2005-01-01

    This review highlights the non-clinical training needs of new consultants, identifying strategies for meeting these needs. Non-clinical activities are integral to the consultant's role and senior clinicians need training in these areas. Concerns over the quantity and quality of current provision are compounded by changes the European Working Time Directive and Modernising Medical Careers initiative will bring. Accelerated progression to senior level and reduction in time for training suggest ...

  3. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  4. Integrating corpus consultation in language studies

    OpenAIRE

    Angela Chambers

    2005-01-01

    peer-reviewed Alongside developments in language research, the potential of corpora as a resource in language learning and teaching has been evident to researchers and teachers since the late 1960s. Despite publications which emphasise the benefits of corpus consultation for language learners (Bernardini, 2002; Kennedy & Miceli, 2001), there is little evidence to suggest that direct corpus consultation is coming to be seen as a complement or alternative to consultation of a dictionary, cou...

  5. Understanding the impact of residents' interpersonal relationships during emergency department referrals and consultations.

    Science.gov (United States)

    Chan, Teresa; Sabir, Kameron; Sanhan, Sarila; Sherbino, Jonathan

    2013-12-01

    Communicating with colleagues is a key physician competency. Yet few studies have sought to uncover the complex nature of relationships between referring and consulting physicians, which may be affected by the inherent relationships between the participants. Our study examines themes identified from discussions about communications and the role of relationships during the referral-consultation process. From March to September 2010, 30 residents (10 emergency medicine, 10 general surgery, 10 internal medicine) were interviewed using a semistructured focus group protocol. Two investigators independently reviewed the transcripts using inductive methods and grounded theory to generate themes (using codes for ease of analysis) until saturation was reached. Disagreements were resolved by consensus, yielding an inventory of themes and subthemes. Measures for ensuring trustworthiness of the analysis included generating an audit trail and external auditing of the material by investigators not involved with the initial analysis. Two main relationship-related themes affected the referral-consultation process: familiarity and trust. Various subthemes were further delineated and studied in the context of pertinent literature. Relationships between physicians have a powerful influence on the emergency department referral-consultation dynamic. The emergency department referral-consultation may be significantly altered by the familiarity and perceived trustworthiness of the referring and consulting physicians. Our proposed framework may further inform and improve instructional methods for teaching interpersonal communication. Most importantly, it may help junior learners understand inherent difficulties they may encounter during the referral process between emergency and consulting physicians.

  6. Communicating with child patients in pediatric oncology consultations : a vignette study on child patients', parents', and survivors' communication preferences

    NARCIS (Netherlands)

    Zwaanswijk, Marieke; Tates, Kiek; van Dulmen, Sandra; Hoogerbrugge, Peter M.; Kamps, Willem A.; Beishuizen, A.; Bensing, Jozien M.

    2011-01-01

    Objective: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Methods: Preferences regarding health-care provider empathy in consultations, and c

  7. Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences

    NARCIS (Netherlands)

    Zwaanswijk, M.; Tates, K.; Dulmen, S. van; Hoogerbrugge, P.M.; Kamps, W.A.; Beishuizen, A.; Bensing, J.M.

    2011-01-01

    OBJECTIVE: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. METHODS: Preferences regarding health-care provider empathy in consultations, and c

  8. Communicating with child patients in pediatric oncology consultations: a vignette study on child patients', parents', and survivors' communication preferences.

    NARCIS (Netherlands)

    Zwaanswijk, M.; Tates, K.; Dulmen, S. van; Hoogerbrugge, P.M.; Kamps, W.A.; Beishuizen, A.; Bensing, J.M.

    2011-01-01

    Objective: To investigate the preferences of children with cancer, their parents, and survivors of childhood cancer regarding medical communication with child patients and variables associated with these preferences. Methods: Preferences regarding health-care provider empathy in consultations, and c

  9. Case Complexity and Quality Attestation for Clinical Ethics Consultants.

    Science.gov (United States)

    Spielman, Bethany; Craig, Jana; Gorka, Christine; Miller, Keith

    2015-01-01

    A proposal by the American Society for Bioethics and Humanities (ASBH) to identify individuals who are qualified to perform ethics consultations neglects case complexity in candidates' portfolios. To protect patients and healthcare organizations, and to be fair to candidates, a minimum case complexity level must be clearly and publicly articulated. This proof-of-concept study supports the feasibility of assessing case complexity. Using text analytics, we developed a complexity scoring system, and retrospectively analyzed more than 500 ethics summaries of consults performed at an academic medical center during 2013. We demonstrate its use with seven case summaries that range in complexity from uncomplicated to very complicated. We encourage the ASBH to require a minimum level of case complexity, and recommend that attestation portfolios include several cases of moderate complexity and at least one very complex case.

  10. Consulting--Part 2. The art and science of using consultants.

    Science.gov (United States)

    Lister, E D; Pirrotta, S

    1996-11-01

    Part I of this series described a research project--a survey of more than 300 physician executives. Asked to share their personal experiences of unsuccessful consultations, our correspondents painted a clear picture of what can go wrong when organizational consultants enter health care systems, and described the lasting destructive sequelae to failed consultations. The two issues responsible for most failed consultations were the intrusion of internal politics into the process and the failure to clearly establish and maintain consensual goals. In Part 2, the consultation process is explored from a very different perspective. What are the issues that often trigger requests for consultation services, as well as the dynamics that can foreshadow success or failure before consultants are even engaged? What are the pitfalls and pointers for the successful use of consultation services?

  11. 2003-2006年民航空勤人员医学临时停飞原因分析%Analysis of medical causes leading to civil aircrew temporary grounding from 2003 to 2006

    Institute of Scientific and Technical Information of China (English)

    杨斌; 梁谷米; 于红燕; 张齐云; 仲西蒙; 续文; 顾明; 周毓瑾

    2011-01-01

    目的 分析民航空勤人员医学临时停飞原因与特点,为航卫保障工作提供可靠的临床流行病学依据.方法 对2003年至2006年度516例东方航空江苏有限公司空勤人员因医学原因临时停飞情况进行调查,其中飞行员123人,空中乘务员342人,空中安全员51人.分析不同年度、不同职别人员医学临时停飞原因及临时停飞天数.应用SPSS 13.0统计软件进行统计分析.结果 ①临时停飞疾病居前10位的是上呼吸道感染、急性肠炎、气压性中耳炎、急性胃肠炎、软组织损伤、急慢性胃炎、痛经和月经不调、扁桃体炎、腰扭伤和腰肌劳损、皮炎.②上呼吸道感染是引起医学临时停飞的首要原因,高血压、气压性中耳炎、妊娠分别是飞行员、空中安全员、空中乘务员医学临时停飞的主要原因.③上呼吸道感染和气压性中耳炎在医学临时停飞总天数中位居前列,骨折、烫伤、肾炎及肾盂肾炎以及腰椎间盘突出症在单次医学临时停飞天数中位居前列.结论 应加强对空勤人员的健康教育,有针对性地开展预防工作,使其加强体质锻炼,养成良好生活习惯,降低医学临时停飞率.%Objective To analyze the characteristics and causes leading to civil aircrew medical temporary grounding and to provide the clinical epidemiology reference for aeromedical protection.Methods The constituent ratio of grounding cases and days of medical temporary grounding from 2003 to 2006 in China Eastern Airlines Jiangsu Ltd.were investigated and statistically analyzed by SPSS 13.0 software.Results The top ten diseases led to 516 aircrew medical temporary grounding in China Eastern Airlines Jiangsu Ltd.were upper respiratory tract infection,acute enteritis,barotraumatic otitis media,acute gastroenteritis,soft tissue injury,acute or chronic gastritis,dysmenorrhea and menoxenia,tonsillitis,lumbar sprain and lumbar muscle strain and dermatitis.Upper respiratory

  12. Matched comparison of GP and consultant rating of electronic discharge summaries.

    Science.gov (United States)

    Stainkey, Lesley; Pain, Tilley; McNichol, Margaret; Hack, John; Roberts, Lynden

    2010-01-01

    Queensland Health is implementing a state-wide system to electronically generate and distribute discharge summaries. Previously, general practitioners (GPs) have indicated that the quality of the discharge summary does not support clinical handover. While the electronic system will address some issues (e.g. legibility and timeliness), the quality of the discharge summary content is predominantly independent of method of generation. As discharge summaries are usually generated by interns, we proposed that improvement in the quality of the summary may be achieved through education. This project aimed to compare the perceptions of hospital-based consultant educators and recipient GPs regarding discharge summary content and quality. The discharge summary and audit tool were sent to the recipient GP (n=134) and a hospital consultant (n=14) for satisfaction rating, using a 5- point Likert scale for questions relating to diagnosis, the listing of clinical management, medication, pathology, investigations, and recommendations to GP. Sampling was performed by selecting up to 10 discharge summaries completed by each first-year intern (n=36) in 2009, during the second, third and fourth rotations at the Townsville Hospital until a total of 403 was reached. Matched responses were compared using the Kappa statistic. The response rate was 93% (n=375) and 63% (n=254) for consultants and GPs respectively. Results from this study demonstrated that GPs were more satisfied with discharge summaries than were consultants. An anomaly occurred in three questions where, despite the majority of GPs rating satisfied or very satisfied, a small but proportionally greater number of GPs were very dissatisfied when compared with consultants. Poor or fair agreement between GPs and consultants was demonstrated in medications, pathology results, investigations and recommendations to GP, with GPs rating higher satisfaction in all questions. Lower consultant satisfaction ratings compared with GP

  13. Education, consultation, guidance, students, advisor, teacher

    Directory of Open Access Journals (Sweden)

    M Seyedmajidi

    2013-09-01

    Full Text Available Introduction: Student counseling and supervision play an important role to overcome learning problems and to achieve educational goals. The present study is intended to investigate viewpoints of students regarding educational guidance and advice studying at Babol University of Medical Sciences. Methods: In this descriptive cross-sectional survey, viewpoints of 480 students were collected by a questionnaire. The validity and reliability of the questionnaire had been approved before. Data were analyzed using SPSS version 17 software. Chi- square and ANOVA tests were administered. Results: 61.2% of all participants were female and 38.8% were males with mean age of 21.3±4.0. 37.2% of these students lacked sufficient knowledge and information on how to request from their advisors for help and guidance. Half of students (50.3% reported attendance of advisors and holding routine consultation is inappropriate. Advisors made more educational files for females compare to males (P=0.001. No difference observed regarding educational disciplines of the advisors regarding students were dissatisfied with help and guidance received from paramedics and dentistry students in most fields (87.3% and 81.5% respectively. Conclusion: It seems that either student has no sufficient information about tasks of advisors and/or advisors may not do their tasks properly. It is recommended the students to be acquainted with advisors’ tasks upon their entrance into the university. Training classes for new academics would be helpful.

  14. Clinical supervision by consultants in teaching hospitals.

    Science.gov (United States)

    Hore, Craig T; Lancashire, William; Fassett, Robert G

    2009-08-17

    Clinical supervision is a vital part of postgraduate medical education. Without it, trainees may not learn effectively from their experiences; this may lead to acceptance by registrars and junior doctors of lower standards of care. Currently, supervision is provided by consultants to registrars and junior doctors, and by registrars to junior doctors. Evidence suggests that the clinical supervision provided to postgraduate doctors is inadequate. Registrars and juniors doctors have the right to expect supervision in the workplace. Impediments to the provision of clinical supervision include competing demands of hospital service provision on trainees and supervisors, lack of clarity of job descriptions, private versus public commitments of supervisors and lack of interest. Supervisors should be trained in the process of supervision and provided with the time and resources to conduct it. Those being supervised should be provided with clear expectations of the process. We need to create and develop systems, environments and cultures that support high standards of conduct and effective clinical supervision. These systems must ensure the right to supervision, feedback, support, decent working conditions and respect for both trainees and their supervisors.

  15. [Feasibility of consultation - liaison psychiatry in a large general hospital: quantitative description of services and personnel expenditure].

    Science.gov (United States)

    Windhager, Elmar; Thaler, Katharina; Selberis-Vahl, Wilia Vasiliki; Friedl-Wörgetter, Petra; Windhager, Isabella; Zauner, Katharina

    2015-01-01

    The integration of psychiatric departments in general hospitals lead to an increasing demand of psychiatric consultation, which often overstrains personnel resources of short staffed psychiatric services. To provide consulting service, as it is demanded by guidelines, a multidisciplinary consulting team could be a possible solution. A retrospective descriptive analysis of all consultations made by the psychosocial consultation and liaison service at the general hospital Wels-Grieskirchen in the years 2012 and 2013. There was an increase in referrals overall of 22 % from 2012 to 2013. The largest increase was observed in the group of psychiatrists, who carried out 33.1 % of all consultations. Most consultations, 39.5 %, were done by the group of clinical psychologists, partly substituting medical attendance. Taking together both occupational groups, the expected number of consultations of at least 3 % of all admissions could be achieved. A multidisciplinary consulting team consisting of psychiatrists, psychologists, psychosomatic physicians and social workers staffed with 5.11-6.79 full-time personnel is able to provide psychosocial consultation service at a quantitative level required by international guidelines.

  16. A Qualitative Metasynthesis of Consultation Process Research: What We Know and Where to Go

    Science.gov (United States)

    Newman, Daniel S.; McKenney, Elizabeth L. W.; Silva, Arlene E.; Clare, Mary; Salmon, Diane; Jackson, Safiyah

    2017-01-01

    Qualitative metasynthesis (QM) is a research methodology that permits the meaningful integration and interpretation of qualitative research. This study applies a QM approach combined with constructivist grounded theory methods, bolstered by several features of research credibility, to examine the state of consultee-centered consultation (CCC) and…

  17. Consultation-liaison psychiatry in China%中国会诊联络精神医学现状

    Institute of Scientific and Technical Information of China (English)

    季建林; 叶尘宇

    2012-01-01

    Consultation-liaison psychiatry (CLP) was first established in China after liberation in 1949. It has developed more rapidly over the last two decades but, despite major regional differences in the level of CLP, the overall practice of CLP in the country remains quite basic, largely limited to case-based consultation with other medical departments. There is little ongoing collaboration between departments of psychiatry and other departments, and medical students and non-psychiatric clinicians rarely get training in CLP.

  18. Grounded theory.

    Science.gov (United States)

    Harris, Tina

    2015-04-29

    Grounded theory is a popular research approach in health care and the social sciences. This article provides a description of grounded theory methodology and its key components, using examples from published studies to demonstrate practical application. It aims to demystify grounded theory for novice nurse researchers, by explaining what it is, when to use it, why they would want to use it and how to use it. It should enable nurse researchers to decide if grounded theory is an appropriate approach for their research, and to determine the quality of any grounded theory research they read.

  19. Competency-Based Behavior Consultation Training: An Evaluation of Consultant Outcomes, Treatment Effects, and Consumer Satisfaction

    Science.gov (United States)

    Lepage, Kathy; Kratochwill, Thomas R.; Elliott, Stephen N.

    2004-01-01

    Assessments of consultants, clients, and consumer satisfaction were used to examine the effects of a competency-based consultation training program conducted over 4 years. Using a multiple-baseline framework to assess training effects on consultants and single-case study designs to evaluate changes in client behavior, a number of significant…

  20. Linking Knowledge and Action: PRI's Community Consultant.

    Science.gov (United States)

    Spencer, Gregory P.

    Within the Partnership for Rural Improvement (PRI), community consultants operate within three complex sets of relationships: client groups, the organizational structure of PRI, and the local operational base. Community consultants are responsible for developing and facilitating rural development and for providing assistance in community and…

  1. Consulting Careers: A Profile of Three Occupations

    Science.gov (United States)

    Mullins, John

    2011-01-01

    Choosing an industry in which to work is often as important as choosing an occupation. And over the next several years, the best advice for some workers may be to choose an industry that sells advice: consulting. The management, scientific, and technical consulting services industry comprises businesses that offer specialized advice to other…

  2. The Consulting Challenge: A Case Competition

    Science.gov (United States)

    Sachau, Daniel A.; Naas, Patricia A.

    2010-01-01

    The Consulting Challenge is a yearly case competition in which teams of graduate students respond to a request for proposals (RFP) for consulting services. The case and RFP are based on a problem that a host organization has experienced. Over 3 days, students meet with representatives of the host organization, analyze data, prepare a proposal for…

  3. Capturing the Competence of Management Consulting Work

    Science.gov (United States)

    Visscher, Klaasjan

    2006-01-01

    Purpose: The purpose of this article is to assess whether the effort of consulting firms and branch organizations to establish a shared and standardized methodology as a means to professionalize consulting and as a standard for training is possible and sensible. Design/methodology/approach: A survey was conducted among Dutch management…

  4. Linking Knowledge and Action: PRI's Community Consultant.

    Science.gov (United States)

    Spencer, Gregory P.

    Within the Partnership for Rural Improvement (PRI), community consultants operate within three complex sets of relationships: client groups, the organizational structure of PRI, and the local operational base. Community consultants are responsible for developing and facilitating rural development and for providing assistance in community and…

  5. How to Hire a Search Consultant.

    Science.gov (United States)

    Lester, Virginia L.

    1993-01-01

    Increasingly, colleges and universities are using consultants to help search committees find the right president for the institution. Search consultants bring experience, historical and national perspectives, objectivity, personal knowledge of candidates, and a professional approach. Energy, enthusiasm, and style are important consultant…

  6. Patient expectations from consultation with family physician.

    NARCIS (Netherlands)

    Tähepöld, H.; Brink-Muinen, A. van den; Maaroos, H.I.

    2006-01-01

    Aim: To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process. Method: We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped

  7. ARL/OMS Consultant Training Program.

    Science.gov (United States)

    Euster, Joanne R.

    1982-01-01

    Describes Academic Library Consultant Training Program begun in 1979, sponsored by Office of Management Studies (OMS) and designed to provide 80 consultants to aid academic libraries in improving performance. Viewpoints are included from OMS Director and participants concerning program objectives, trainee selection, workshops, internships, and the…

  8. Capturing the competence of management consulting work

    NARCIS (Netherlands)

    Visscher, Klaasjan

    2006-01-01

    Purpose: The purpose of this article is to assess whether the effort of consulting firms and branch organizations to establish a shared and standardized methodology as a means to professionalize consulting and as a standard for training is possible and sensible. - Design/methodology/approach: A su

  9. Providing specialty consultant expertise to primary care: an expanding spectrum of modalities.

    Science.gov (United States)

    Kirsh, Susan R; Ho, P Michael; Aron, David C

    2014-10-01

    In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.

  10. Consulting by Business College Academics: Lessons for Business Communication Courses

    Science.gov (United States)

    Dave, Anish

    2009-01-01

    Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

  11. Consulting by Business College Academics: Lessons for Business Communication Courses

    Science.gov (United States)

    Dave, Anish

    2009-01-01

    Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…

  12. CONSULTATION ON UPDATED METHODOLOGY FOR ...

    Science.gov (United States)

    The National Academy of Sciences (NAS) expects to publish the Biological Effects of Ionizing Radiation (BEIR) committee's report (BEIR VII) on risks from ionizing radiation exposures in calendar year 2005. The committee is expected to have analyzed the most recent epidemiology from the important exposed cohorts and to have factored in any changes resulting from the updated analysis of dosimetry for the Japanese atomic bomb survivors. To the extent practical, the Committee will also consider any relevant radiobiological data, including those from the Department of Energy's low dose effects research program. Based on their evaluation of relevant information, the Committee is then expected to propose a set of models for estimating risks from low-dose ionizing radiation. ORIA will review the BEIR VII report and consider revisions to the Agency's methodology for estimating cancer risks from exposure to ionizing radiation in light of this report and other relevant information. This will be the subject of the Consultation. This project supports a major risk management initiative to improve the basis on which radiation risk decisions are made. This project, funded by several Federal Agencies, reflects an attempt to characterize risks where there are substantial uncertainties. The outcome will improve our ability to assess risks well into the future and will strengthen EPAs overall capability for assessing and managing radiation risks. the BEIR VII report is funde

  13. The Consultation of the Puericulture.

    Directory of Open Access Journals (Sweden)

    Rotardo Rafael Navarro Ruíz

    2010-06-01

    Full Text Available He/she was carried out a bibliographical revision related with the topic Puericulture with the objective of deepening in the knowledge related with the topic, keeping in mind that it is the consultation, par excellence, of the Primary Attention that takes charge of the care and the minor cultivation from a lot before the conception. The visit of the children and young to their doctor, without problems of health mediate they allow to evaluate the integral operation of these and to guide the parents on as acting before possible situations that are presented we Also insist in the different subespecialitys that compose the Puericulture like they are: Puericulture Preconcepcional, Intra-uterine Puericulture and or Prenatal, Puericulture Neonatal, Puericulture of the Infant, Puericulture of the Naive one, Puericulture of the Scholar, the adolescent's Puericulture and that of the boy handicapped. We stand out that this realized activity with quality guarantees the full health of the children, through the clinical exam and other observations we can identify and to diagnose some situation of health that can arise precociously and to diminish future problems.

  14. Otolaryngology Consult Carts: Maximizing Patient Care, Surgeon Efficiency, and Cost Containment.

    Science.gov (United States)

    Royer, Mark C; Royer, Allison K

    2015-11-01

    The objective of this study was to develop an otolaryngology consult cart system to ensure prompt delivery to the bedside of all the unique equipment and medications required for emergent and urgent otolaryngology consults. An otolaryngology practice responsible for emergency room and hospital consult coverage sought to create a cart containing all equipment, medications, and supplies for otolaryngology consults. Meetings with hospital administration and emergency room, nursing, pharmacy, central processing, and operating room staff were held to develop a system for the emergent delivery of the cart to the needed location, sterilization and restocking of equipment between uses, and appropriate billing of supplies. Two months were required from conception to implementation. All equipment was purchased new, including flexible scopes and headlights. The cart is sterilized, restocked, and maintained by central processing after each use. The equipment is available to handle all airway emergencies as well as all common otolaryngology consults and is delivered bedside in less than 5 minutes. The development of a self-contained otolaryngology consult cart requires coordination with a wide variety of hospital departments. This system, while requiring initial monetary and time investment, has resulted in improved patient care, cost containment, and surgeon convenience. © The Author(s) 2015.

  15. From Solution Shop to Boutique Consulting? Capturing Recent Developments on the German Consulting Marke

    Directory of Open Access Journals (Sweden)

    Jörg Jasper DÖTSCH

    2016-12-01

    Full Text Available Digitalization, globalization, new technologies and shorter product life cycles are only a few keywords underlining the fact that companies are under increasing pressure for faster adaptation, innovation and hence applying a higher knowledge intensity. We assume that these conditions require an increasingly important role of consulting companies, because they seem to be the intermediaries needed to bridge the faster growing gaps between existing business models, organizational structures and accelerating market change. Market pressure is growing on the market for consultant companies as well. New technologies and digitalization should influence both the structure of the consultancy market and the business models of consultancies. Christensen suggested a trend from Dzsolution shop” to Dzboutique consulting.” To track current developments, we concentrate on the German consulting market as one of the most important consultant markets worldwide and explore changes of the last two years based on various studies. Processes of change seem to be both substantially driven by digitalization and to reflect change on the non-consultancy markets. A high willingness to switch among providers documents a high pressure on performance. The impact of digitalisation seem• to be observable in structural and qualitative change. With regard to the German consulting market and the latest available data we cannot validate a tendency from a dominance of “solution shop” consultancies to “boutique” consultancy services.

  16. Can audio recording of outpatient consultations improve patients recall and understanding?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken

    clinicians, the communication is challenged by the fact that patients tend to forget or misunderstand parts of the information given. Thus we have designed a study which gives the patients a possibility to hear their consultation again. An Interactive Voice Response platform enables an audio recording......Introduction Information provided in an outpatient consultation concerns medication, diagnostic tests, treatment and rehabilitation, all of which are crucial knowledge with regards to patient compliance, decision making and general patient satisfaction. Despite good communication skills among...... of the dialogue between the patient and the clinician via the telephone in the consultation room. By dialing a dedicated number, patients can get access to an audio recording of their consultation by entering their social security number along with a PIN. The primary objective of this study is to determine...

  17. Patients’ perspectives on antenatal group consultations: Identifying communicative strengths and weaknesses

    DEFF Research Database (Denmark)

    Jensen, Matilde Nisbeth; Fage-Butler, Antoinette Mary

    consultations, followed by an observation study of group consultations at the same clinic. Results: Analysis identified the value of placing patients together, as it helped to normalize pregnancy which otherwise can be medicalized in the healthcare setting. The sharing of personal experiences had a reassuring......-patient communication, which is increasingly taking place in online patient communities. One novel offline setting which can support patient-patient communication is the group consultation where an individual healthcare professional and a group of patients engage. The purpose of this study is to investigate how patient......-patient communication unfolds in a group consultation with a midwife in order to identify its communicative strengths and weaknesses. Methods: Using a sequential multi-methods design, we performed eight individual interviews with pregnant women from a Danish antenatal clinic about their experiences of two group...

  18. New Pattern of Consultation Reengineering Based on IT Platform%基于信息技术平台的医院会诊模式重建

    Institute of Scientific and Technical Information of China (English)

    高玮; 钟力炜; 傅春瑜

    2012-01-01

    Clinical consultation is one part of medical activities in the hospital. The system of consultation is one of medical service systems. Based on IT platform, the traditional consultation style is changed into the new pattern of consultation. IT platform will play an important role in consultation management, medical quality control and medical safety ensurance.%临床会诊是医院一项经常性医疗活动,会诊制度也是一项基本的医疗制度.利用信息技术平台,改变原有的传统会诊模式,再造新型的电子会诊模式,对于加强医疗会诊管理,控制医疗质量,确保医疗安全可起到重要的作用.

  19. Grounded cognition.

    Science.gov (United States)

    Barsalou, Lawrence W

    2008-01-01

    Grounded cognition rejects traditional views that cognition is computation on amodal symbols in a modular system, independent of the brain's modal systems for perception, action, and introspection. Instead, grounded cognition proposes that modal simulations, bodily states, and situated action underlie cognition. Accumulating behavioral and neural evidence supporting this view is reviewed from research on perception, memory, knowledge, language, thought, social cognition, and development. Theories of grounded cognition are also reviewed, as are origins of the area and common misperceptions of it. Theoretical, empirical, and methodological issues are raised whose future treatment is likely to affect the growth and impact of grounded cognition.

  20. INTEGRATING CORPUS CONSULTATION IN LANGUAGE STUDIES

    Directory of Open Access Journals (Sweden)

    Angela Chambers

    2005-05-01

    Full Text Available Alongside developments in language research, the potential of corpora as a resource in language learning and teaching has been evident to researchers and teachers since the late 1960s. Despite publications which emphasise the benefits of corpus consultation for language learners (Bernardini, 2002; Kennedy & Miceli, 2001, there is little evidence to suggest that direct corpus consultation is coming to be seen as a complement or alternative to consultation of a dictionary, course book, or grammar by the majority of learners. There is thus a need for research to underpin the integration of corpora and concordancing in the language-learning environment.This study begins with an account of published research relating to course design and structure in the area of corpus consultation by language learners. The focus then narrows to the initial training of learners in corpus consultation, using as an example a course involving undergraduate students on several language degree programmes. The results of the students' consultation of the corpora are examined, including choice of search word(s, analytical skills, the problems encountered, and their evaluation of the activity. The results reveal how corpus consultation can complement traditional language-learning resources, while also raising questions concerning its integration in the language-learning environment.

  1. Research ethics consultation: ethical and professional practice challenges and recommendations.

    Science.gov (United States)

    Sharp, Richard R; Taylor, Holly A; Brinich, Margaret A; Boyle, Mary M; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

    2015-05-01

    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical and Translational Science Award Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: (1) managing multiple institutional roles and responsibilities, (2) managing sensitive information, and (3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services.

  2. Research Ethics Consultation: Ethical and Professional Practice Challenges and Recommendations

    Science.gov (United States)

    Sharp, Richard R.; Taylor, Holly A.; Brinich, Margaret A.; Boyle, Mary M.; Cho, Mildred; Coors, Marilyn; Danis, Marion; Havard, Molly; Magnus, David; Wilfond, Benjamin

    2015-01-01

    The complexity of biomedical research has increased considerably in the last decade, as has the pace of translational research. This complexity has generated a number of novel ethical issues for clinical investigators, institutional review boards (IRBs), and other oversight committees. In response, many academic medical centers have created formal research ethics consultation (REC) services to help clinical investigators and IRBs navigate ethical issues in biomedical research. Key functions of a REC service include: assisting with research design and implementation, providing a forum for deliberative exploration of ethical issues, and supplementing regulatory oversight. As increasing numbers of academic research institutions establish REC services, there is a pressing need for consensus about the primary aims and policies that should guide these activities. Establishing clear expectations about the aims and policies of REC services is important if REC programs are to achieve their full potential. Drawing on the experiences of a Clinical Translational Science Award (CTSA) Research Ethics Consultation Working Group, this article describes three major ethical and professional practice challenges associated with the provision of REC: 1) managing multiple institutional roles and responsibilities, 2) managing sensitive information, and 3) communicating with consultation requestors about how these issues are managed. The paper also presents several practical strategies for addressing these challenges and enhancing the quality of REC services. PMID:25607942

  3. The frequency of dietary references in homeopathic consultations.

    Science.gov (United States)

    Filho, Rubens Dolce

    2011-07-01

    A retrospective quantitative study on dietary references found in medical records of 2753 patients attending consultations from 10/1/1994 to 5/31/2007 was conducted. The symptoms found in the rubrics relating to food and drink aggravation and amelioration, aversion and craving of homeopathic repertories reflect diets at different places and times and do not correspond fully, to contemporary gastronomy. Desires for sweet and spicy foods were statistically more frequent, revealing the prevailing taste for such food among the studied population. Food cravings should be carefully analyzed before considering them as indications for choosing homeopathic therapy, they are less significant than aversions, aggravations and ameliorations.

  4. Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center.

    Science.gov (United States)

    Choi, Kevin J; Kahmke, Russel R; Crowson, Matthew G; Puscas, Liana; Scher, Richard L; Cohen, Seth M

    2017-05-01

    The consultation patterns of an otolaryngology-head and neck surgery service have not previously been reported. The time, resources, and attention required to operate such a consultation service are unknown. To assess trends in otolaryngology-head and neck surgery consultations conducted in emergency departments (EDs) and inpatient services. A retrospective analysis was conducted of the medical records of patients at a quaternary care center receiving inpatient otolaryngology consultations from January 1 to December 31, 2014. Clinical evaluation and bedside and operative procedures performed by the otolaryngology-head and neck surgery service. Demographics, reason for consultation, diagnosis, bedside procedures, operative interventions, and admission variables. A total of 1491 consultations were completed for adult (1091 [73.2%]; 854 men and 637 women; mean [SD] age 50.3 [19.3] years) and pediatric (400 [26.8%]; 232 boys and 168 girls; mean [SD] age, 4.0 [5.2] years) patients. Of the 1491 consultations, 766 (51.4%) originated from inpatient teams vs 725 (48.6%) from the ED. A total of 995 of all consultations (66.7%) resulted in a bedside procedure, and 243 (16.3%) required operative intervention. Consultations regarding airway evaluation (362 [47.3%] vs 143 [19.7%]), management of epistaxis (78 [10.2%] vs 33 [4.6%]), and rhinologic evaluation (79 [10.3%] vs 18 [2.5%]) were more frequent from inpatient teams than from the ED. Consultations regarding management of head and neck infections (162 [22.3%] vs 32 [4.2%]), facial trauma (235 [32.4%] vs 16 [2.1%]), and postoperative complications (73 [10.1%] vs 2 [0.3%]) were more frequent in the ED. Of the 725 consultations performed in the ED, 212 patients (29.2%) required hospitalization. The consultation volume of an otolaryngology-head and neck surgery service requires significant time and resources. Consultations are most often for rhinologic or laryngologic issues and are reflective of the clinical setting in which

  5. Postpartum consultation: Occurrence, requirements and expectations

    Directory of Open Access Journals (Sweden)

    Carlgren Ingrid

    2008-07-01

    Full Text Available Abstract Background As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results Of the 150 interviewed women, 56% (n = 84 had a postpartum consultation of which 61.9% (n = 52 had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.

  6. Osteoporosis screening and treatment among veterans with recent fracture after implementation of an electronic consult service.

    Science.gov (United States)

    Lee, Richard H; Lyles, Kenneth W; Pearson, Megan; Barnard, Karen; Colón-Emeric, Cathleen

    2014-06-01

    Fewer than 24% of Veterans received appropriate evaluation and/or treatment for osteoporosis within 6 months of an index fracture. An electronic consult (E-consult) service was implemented at three Veterans Affairs Medical Centers to facilitate the identification of and recommend management for patients with recent fracture. The E-consult service used clinical encounter data based on ICD9 diagnosis codes to prospectively identify patients with potential osteoporotic fractures. Eligible patients' medical records were reviewed by a metabolic bone specialist, and an E-consult note was sent to the patient's primary provider with specific recommendations for further management. Recommendations were initiated at the provider's discretion. Between 2011 and 2013, the E-consult service identified 444 eligible patients with a low-trauma fracture who were not already on treatment. One hundred twenty-nine (29.1%) consults recommended immediate bisphosphonate treatment, and 258 (58.1%) recommended bone density assessments. Primary providers responded by prescribing bisphosphonates in 74 patients (57.4%) and by ordering bone density testing in 183 (70.9%) patients. At the facility level, prior to implementation of the E-consult service, the rate of osteoporosis treatment following a fracture was 4.8% for bisphosphonates and 21.3% for calcium/vitamin D. After implementation, the treatment rate increased to 7.3% for bisphosphonates (p = 0.02) and 35.2% for calcium/vitamin D (p E-consult service modestly improved the rate of osteoporosis treatment among patients with a recent fracture. These results suggest that a program with direct patient interaction is probably required to substantially improve treatment rates.

  7. The Use of Dexamethasone in Support of High-Altitude Ground Operations: Review of the Literature & Current Training of U.S. Special Operations Medical Members

    Science.gov (United States)

    2013-03-14

    8) 8 mg twice daily starting the day before the ascent to 4,559 m throughout the 2-day study Dexamethasone improved VO2 - max (pɘ.05) and...4,559 m Dexamethasone improved VO2 - max (p=0.025); no significant difference existed in arterial O2 saturation during maximal exercise...AFRL-SA-WP-SR-2013-0006 The Use of Dexamethasone in Support of High-Altitude Ground Operations: Review of the Literature & Current

  8. 20 CFR 416.1016 - Medical or psychological consultants.

    Science.gov (United States)

    2010-04-01

    ... licensed or certified as a psychologist at the independent practice level of psychology by the State in which he or she practices; and (2)(i) Possesses a doctorate degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the...

  9. 20 CFR 404.1616 - Medical or psychological consultants.

    Science.gov (United States)

    2010-04-01

    ... licensed or certified as a psychologist at the independent practice level of psychology by the State in which he or she practices; and (2)(i) Possesses a doctorate degree in psychology from a program in clinical psychology of an educational institution accredited by an organization recognized by the...

  10. [Structured electronic consultation letter for shoulder disorders].

    Science.gov (United States)

    Paloneva, Juha; Oikari, Marjo; Ylinen, Jari; Ingalsuo, Minna; Ilkka, Kunnamo; Ilkka, Kiviranta

    2012-01-01

    Referral to a specialist has a significant influence on management of the patient and costs associated with the treatments. However, development and research of the process by which patients are referred has been almost neglected. Expectations considering the purpose, contents, and timing of the referral of the consulting physician and the consultant do not always meet. A structured, electronic consultation letter was developed to respond this need. Functionality and interactivity are the key elements of the referral, including (1) an electronic referral letter to a specialist, (2) interactive education in clinical examination and management of shoulder disorders, and (3) an instrument of clinical examination and documentation of shoulder disorders.

  11. Medical Abortion.

    Science.gov (United States)

    Costescu, Dustin; Guilbert, Edith; Bernardin, Jeanne; Black, Amanda; Dunn, Sheila; Fitzsimmons, Brian; Norman, Wendy V; Pymar, Helen; Soon, Judith; Trouton, Konia; Wagner, Marie-Soleil; Wiebe, Ellen; Gold, Karen; Murray, Marie-Ève; Winikoff, Beverly; Reeves, Matthew

    2016-04-01

    This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care. Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services. Women with an unintended first trimester pregnancy. Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required. The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1). Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability. Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  12. 24 CFR 91.100 - Consultation; local governments.

    Science.gov (United States)

    2010-04-01

    ... Urban Development CONSOLIDATED SUBMISSIONS FOR COMMUNITY PLANNING AND DEVELOPMENT PROGRAMS Citizen Participation and Consultation § 91.100 Consultation; local governments. (a) General. (1) When preparing...

  13. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.

    2010-01-01

    possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition......Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature......, taxonomy, epidemiology, etiology, pathology, diagnosis, symptom scales, outcome assessment, principles of management, specific therapies, and future directions in research. Study Design, Materials, Methods: The emphasis was on new information developed since the last consultation 4 years previously. Where...

  14. Consulting Informs Best Practice in Academia

    Directory of Open Access Journals (Sweden)

    Risa Blair

    2015-10-01

    Full Text Available The Conversational Plenary Session began with a clear agenda of describing the process and challenge of developing eLearning and eTraining. After a brief discussion of the benefits and challenges of the modality, the conversation quickly segued to a highly spirited conversation related to consulting and the negative implications when one calls oneself a consultant. In fact, this became an integral theme of multiple discussions throughout the rest of the conference. This author strives to identify a selection of literature which supports the viewpoint that consulting does indeed inform best practices in academia. Those professors with up-to-the-minute consultancies in their fields offer an enriched experience for their students.

  15. Three Obstacles to Improving Academic Consultation.

    Science.gov (United States)

    Kremer, John F.

    1980-01-01

    Notes three obstacles to improving academic consultation to students: (1) lack of knowledge of techniques to improve student performance; (2) reduction of barriers between students and professors; and (3) needed reinforcements for professors. Suggests strategies for overcoming those problems. (CK)

  16. [A nurse consultation in victimology for minors].

    Science.gov (United States)

    Soudan, Corinne

    2014-10-01

    The nurse consultation is an integral part of the treatment of children and adolescents experiencing psychological distress following traumatic events. Specific support is therefore offered to young patients, in particular through the intervention of a clinical nurse specialist.

  17. Ethics consultation: a dangerous, antidemocratic charlatanry?

    Science.gov (United States)

    Lilje, Christian

    1993-01-01

    Giles Scofield's argument indicates ethics consultants may need to better clarify what in fact they are and what they are not doing, claiming, and striving for. But we must not step back too far. We must neither engage in putting in envious professional claims for exclusive rights in the area of difficult and momentous decisions in healthcare nor get stuck in discussing normative ethics at the level of metaphysics, ontology, and dogmatics (as has happened in Germany for decades). We must not do so especially in view of the achievements of ethics consultation and the growing demand for it by all parties involved, conceded even by sceptics. Ethics consultation, according to Scofield, appears to be dangerous....Let us look more closely at the logic of the argument by discussing the presumed "antidemocratic" nature. The "new tyranny" of thoughts, and the "proper" role of bioethics consultation. Some considerations about the possibility of ethics expertise shall be left for the end.

  18. 265 Statistical Consulting and the African Universities

    African Journals Online (AJOL)

    User

    2011-07-21

    Jul 21, 2011 ... Indexed African Journals Online. An International Multidisciplinary Journal, Ethiopia ... engineering, medicine, public health, psychology, marketing, ..... method and the role of statistics; Statistical Consulting Environments (Life ... intelligible reports, makes presentations using PowerPoint and persuasive.

  19. ACF 2012 Reponse to Tribal Consultation Testimony

    Data.gov (United States)

    U.S. Department of Health & Human Services — On March 5 and 6, 2012, the Administration for Children and Families (ACF) held its annual tribal consultation session in Washington, D.C. This session marked the...

  20. Bladder Pain Syndrome International Consultation on Incontinence

    DEFF Research Database (Denmark)

    Hanno, P.; Lin, A.; Nordling, J.

    2010-01-01

    cytology and cystoscopy are recommended if clinically indicated. Treatment progresses from conservative management through various oral and intravesical therapies, with most surgical therapies reserved for unresponsive cases. Pain management is critical throughout the treatment process. The consultation...

  1. Supporting Group Communication Among UX Consultants

    OpenAIRE

    Feldt, Tommy

    2015-01-01

    Professional User Experience (UX) practitioners have an inherent need for effective group communication practices. If they work as external consultants, the need is arguably even greater. Enterprise Social Media (ESM) technologies have affordances that make them seem promising for this domain. The aim of this thesis is thus to identify the domain-specific communicative needs of UX consultants, and discuss how these might be supported using ESM. A case study was conducted, examining how the ES...

  2. Using Language Consultants in Communicative Language Teaching

    OpenAIRE

    Hiroki, Yamamoto; Makoto, Izumisawa; Graduate School, Meiji University

    2016-01-01

    The purpose of the present study is to introduce a teaching technique using language consultants in communicative language teaching. Language consultant is a role in which a student pays attention to a group member's language use during activities, and provides him/her with corrective and positive feedback after the activities, referring to dictionaries. Its effectiveness in terms of second language (L2) learning and motivation was investigated by using it with 42 English learners at a Japane...

  3. [From paediatric urological care to adult urology. Assessment of a transition consultation for adolescents].

    Science.gov (United States)

    Even, L; Mouttalib, S; Moscovici, J; Soulie, M; Rischmann, P; Game, X; Galinier, P; Bouali, O

    2017-10-01

    the definitive nature of his handicap and the need of medical follow-up throughout his life. Transition consultation makes easier the passage from paediatric care to adult urological care. It allows a smooth change of interlocutors, facilitates subsequent care and improves compliance to medical follow-up. It requires a good collaboration between paediatric and adult care units. Transition responds to an increasing request of adolescents, families, and medical teams, since care rupture during adolescence can have functional and psychological consequences. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  4. Ground Wars

    DEFF Research Database (Denmark)

    Nielsen, Rasmus Kleis

    Political campaigns today are won or lost in the so-called ground war--the strategic deployment of teams of staffers, volunteers, and paid part-timers who work the phones and canvass block by block, house by house, voter by voter. Ground Wars provides an in-depth ethnographic portrait of two...... infrastructures that utilize large databases with detailed individual-level information for targeting voters, and armies of dedicated volunteers and paid part-timers. Nielsen challenges the notion that political communication in America must be tightly scripted, controlled, and conducted by a select coterie...... of professionals. Yet he also quashes the romantic idea that canvassing is a purer form of grassroots politics. In today's political ground wars, Nielsen demonstrates, even the most ordinary-seeming volunteer knocking at your door is backed up by high-tech targeting technologies and party expertise. Ground Wars...

  5. New consultants mastering the role of on-call supervisor: a longitudinal qualitative study

    NARCIS (Netherlands)

    Westerman, M.; Teunissen, P.W.; Fokkema, J.P.; Siegert, C.E.; Vleuten, C.P.M. van der; Scherpbier, A.J.J.A.; Scheele, F.

    2013-01-01

    Context The supervision of specialty registrars during on-call shifts is essential to ensure the quality of both health care and medical education, but has been identified as a major novelty and stressor for new consultants in the transition from specialty training. There is a paucity of research on

  6. Primary care physicians’ experiences of carrying out consultations on the internet

    Directory of Open Access Journals (Sweden)

    Göran Umefjord

    2004-05-01

    Conclusions We conclude that the GPs studied experienced their new role as internet doctors mainly in a positive way, with some limitations. With the increase in consultations on the internet, training in this technique should be integrated into the curricula of medical schools and of continuous professional development (CPD.

  7. The "Commitment Model" for Clinical Ethics Consultations: Society's Involvement in the Solution of Individual Cases.

    Science.gov (United States)

    Fournier, Véronique; Spranzi, Marta; Foureur, Nicolas; Brunet, Laurence

    2015-01-01

    Several approaches to clinical ethics consultation (CEC) exist in medical practice and are widely discussed in the clinical ethics literature; different models of CECs are classified according to their methods, goals, and consultant's attitude. Although the "facilitation" model has been endorsed by the American Society for Bioethics and Humanities (ASBH) and is described in an influential manual, alternative approaches, such as advocacy, moral expertise, mediation, and engagement are practiced and defended in the clinical ethics field. Our Clinical Ethics Center in Paris was founded in 2002 in the wake of the Patients' Rights Act, and to date it is the largest center that provides consultation services in France. In this article we shall describe and defend our own approach to clinical ethics consultation, which we call the "Commitment Model," in comparison with other existing models. Indeed commitment implies, among other meanings, continuity through time, a series of coherent actions, and the realization of important social goals. By drawing on a recent consultation case, we shall describe the main steps of our consultation procedure: interviews with major stakeholders, including patients and proxies; case conferences; and follow up. We shall show why we have chosen the term "commitment" to represent our approach at three different but interrelated levels: commitment towards patients, within the case conference group, and towards society as a whole.

  8. [Gynecological emergencies: A prospective study about patients purpose of consultation and outcome].

    Science.gov (United States)

    Calvo, J; Louges, M A; Sanchez, S; Lipere, A; Duminil, L; Graesslin, O

    2016-11-01

    Aiming to evaluate the profile type, complaint and outcome of patients consulting a gynecologic emergency unit in order to enhance "real" emergencies and improve their management. We enrolled prospectively 308 women consulting to Reims teaching hospital gynecologic emergency unit from the 15th of May to the 25th of June 2013. Two hundred and fifty-seven women (83.4%) spontaneously consulted without previous medical examination. Two hundred and thirty-eight of them (77.3%) had already been through gynecologic emergency units and 99 (32.1%) had no regular follow-up. Pelvic pain and/or metrorragia were registered as main complaint for 219 patients (71.1%). Median age was thirty years old (±11) and an average forty-minute wait was recorded. Gynecologic ultrasound was the first exam to be performed after clinical examination for 255 patients (82.8%). Twenty-two (7.1%) were hospitalized for surgical procedures or medical care, respectively 10 (3.2%) and 12 (3.9%). Among 51 women addressed by another healthcare professional, 9 were hospitalized (17.6%) versus 12 hospitalized (4.7%) out of 257, when consulting without initial professional expertise. A significant relationship between hospitalizations and general practitioner consultation was found with an OR=4.34 (95%CI: 1.51-12.05, P=0.002). Main motive of consultation involving home treatment turned out to be on-going pregnancies (92 patients, 29.9%). A large majority of gynecologic hospital consultations, responsible for time waste and professional monopolizing, can be treated by general practitioners and could contribute to a better management of life-threatening emergencies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  9. [The medical legal grounds of the dispanserization of children dwelling on the radiation polluted territories in the issue of Tchernobyl disaster].

    Science.gov (United States)

    Fetisov, S N; Dubovoĭ, I I

    2008-01-01

    The data related to the dynamics of health conditions of children dwelling on the radiation polluted territories in the issue of Tchernobyl disaster in the Briansk Oblast during last post-disaster twenty years. The main normative documents adopted during the after-disaster period on the federal and regulating the implementation of the specialized dispanserization of population. The stages of children dispanserization during 1986-2005 are defined. The proposals related to the enhancement of the quality of children's dispanserization are brought in. The emphasis is made upon the consolidation of public health activities during the specialized dispanserization and medical checkups of population within the framework of the national project "Health".

  10. An Exploration of Consultation Approaches and Implementation in Heterogeneous Classrooms.

    Science.gov (United States)

    Burdette, Paula J.; Crockett, Jean B.

    1999-01-01

    This review of the literature on consultation in heterogeneous classrooms provides first, an overview of consultation; second, a description of school-based consultation; third, a research synthesis of exemplary studies of school-based consultation; and, finally, suggestions for future research and implications for practice. (Author/DB)

  11. 41 CFR 102-78.30 - Who are consulting parties?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Who are consulting... Preservation § 102-78.30 Who are consulting parties? As more particularly described in 36 CFR 800.2(c), consulting parties are those parties having consultative roles in the Section 106 process (i.e., Section 106...

  12. Consultation of traditional bone setters instead of doctors: is it a sociocultural and educational or social insurance problem?

    Science.gov (United States)

    Gölge, Umut Hatay; Kaymaz, Burak; Kömürcü, Erkam; Eroğlu, Mehmet; Göksel, Ferdi; Nusran, Gürdal

    2015-04-01

    Patients consulting bone setters is common in the eastern and south-eastern regions of Turkey. The reasons for consulting bone setters instead of qualified doctors remains unclear. We investigated the characteristics of such patients who consult traditional bone setters after trauma prior to admission to hospital. In the study, 3,422 of 14,080 patients were investigated admitted to hospital between January 2012 and February 2013 with trauma or sequelae of such who were previously treated by bone setters. The characteristics of these patients and the main reasons for consultation of bone setters instead of doctors were recorded. Most of the patients consulting bone setters were found to be young adults or children. Generally speaking, the poorly educated prefer bone setters despite having social insurance. The most common reason (29.3%) was a general preference and secondarily (27.1%) the fear of being disabled after medical treatment. However, the most common cause of patients' consultation at hospital subsequently was due to complications of treatment (46.8%); indeed the complication rate after bone setters' intervention was found to be 54.8%. Although improvements have occurred in the access to and utilisation of healthcare services, consultation by patients of bone setters seems to be a sociocultural and educational issue rather than a problem of lack of medical insurance. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  13. Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement.

    Science.gov (United States)

    Pawlikowska, Teresa; Zhang, Wenjuan; Griffiths, Frances; van Dalen, Jan; van der Vleuten, Cees

    2012-01-01

    To assess the relationship between observable patient and doctor verbal and non-verbal behaviors and the degree of enablement in consultations according to the Patient Enablement Instrument (PEI) (a patient-reported consultation outcome measure). We analyzed 88 recorded routine primary care consultations. Verbal and non-verbal communications were analyzed using the Roter Interaction Analysis System (RIAS) and the Medical Interaction Process System, respectively. Consultations were categorized as patient- or doctor-centered and by whether the patient or doctor was verbally dominant using the RIAS categorizations. Consultations that were regarded as patient-centered or verbally dominated by the patient on RIAS coding were considered enabling. Socio-emotional interchange (agreements, approvals, laughter, legitimization) was associated with enablement. These features, together with task-related behavior explain up to 33% of the variance of enablement, leaving 67% unexplained. Thus, enablement appears to include aspects beyond those expressed as observable behavior. For enablement consultations should be patient-centered and doctors should facilitate socio-emotional interchange. Observable behavior included in communication skills training probably contributes to only about a third of the factors that engender enablement in consultations. To support patient enablement in consultations, clinicians should focus on agreements, approvals and legitimization whilst attending to patient agendas. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  14. "When are you seeing my patient?"--an analysis of the cardiology consultation service in a teaching hospital.

    LENUS (Irish Health Repository)

    Cronin, E

    2010-05-01

    The provision of an efficient consultation service is essential to the efficient functioning of any hospital. Surprisingly little is known about this activity. We present the first reported evaluation of a cardiology consultation service in an attempt to determine the characteristics, efficiency and workload implications of such a service. We performed an audit of the in-patient cardiology consultation service over a four week period. During this period, 125 consultations were seen, of which 85 (68%) were requested by medical specialties. Consultations were seen in a timely fashion, with 76 (61%) being seen on the same day that the request was received. The most common problem was chest pain, (49 patients; 38%) which was felt to be of cardiac origin in only a minority (20; 40%) of cases. Consultations had significant resource implications for our department, with 35 (28%) procedures being performed, 25 (20%) patients\\' care being taken over, and a further 27 (21.6%) new out-patient referrals generated. Our results indicate that the consultation service considered was efficiently delivered but contributed significantly to the department\\'s workload. The most frequent consultation request was for chest pain that was often non-cardiac in nature.

  15. Improving consultations in oncology: the development of a novel consultation aid

    Science.gov (United States)

    Furber, L; Murtagh, G M; Bonas, S A; Bankart, J G; Thomas, A L

    2014-01-01

    Background: The way in which patients receive bad news in a consultation can have a profound effect in terms of anxiety, depression and subsequent adjustment. Despite investment in well-researched communication skills training and availability of decision-making aids, communication problems in oncology continue to be encountered. Methods: We conducted a mixed-methods study in a large UK Cancer Centre to develop a novel consultation aid that could be used jointly by patients and doctors. Consultations were audio-recorded and both the doctors and the patients were interviewed. We used conversation analysis to analyse the consultation encounter and interpretative phenomenological analysis to analyse the interviews. Key themes were generated to inform the design of the aid. Results: A total of 16 doctors were recruited into the study along with 77 patients. Detailed analysis from 36 consultations identified key themes (including preparation, information exchange, question-asking and decision making), which were subsequently addressed in the design of the paper-based aid. Conclusions: Using detailed analysis and observation of oncology consultations, we have designed a novel consultation aid that can be used jointly by doctors and patients. It is not tumour-site specific and can potentially be utilised by new and follow-up consultations. PMID:24548856

  16. Relocation consequences on an ophthalmology consultation service from an inpatient to outpatient facility

    Directory of Open Access Journals (Sweden)

    Singh JS

    2015-10-01

    Full Text Available Jorawer S Singh,1 Vincent M Imbrogno,2 Mary K Howard,3 Amandip S Cheema,3 Ausra D Selvadurai,4 Surbhi Bansal5 1Department of Ophthalmology, George Washington University, Washington, DC, 2Contemporary Ophthalmology of Erie, Erie, PA, 3Department of Ophthalmology, University at Buffalo, Buffalo, NY, 4OcuSight Eye Care Center, Rochester, NY, 5Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA Importance: This study shows that relocation of an academic ophthalmology residency program from an inpatient to an outpatient setting in western New York does not affect the consult volume but affects management patterns and follow-up rates.Objective: To investigate the effects on the ophthalmology consultation service of an academic program with relocation from a Regional Level-1 Trauma center to an outpatient facility.Design: Consultation notes from 3 years before and 3 years after the University at Buffalo’s (UB Department of Ophthalmology relocation from a Regional Level-1 Trauma center (Erie County Medical Center to an outpatient facility (Ross Eye Institute were obtained from hospital electronic medical records and analyzed.Setting: Hospitalized care and institutional practice.Participants: All inpatient or Emergency Room Ophthalmology consultation patients from the Department of Ophthalmology at UB from 2004 to 2010 (1,379 patients.Exposures: None, this was a retrospective chart review.Main outcome measures: Patient demographics, reason for consult, diagnoses, and ophthalmic procedures performed by the UB Department of Ophthalmology before and after its relocation.Results: Relocation to the outpatient facility did not affect consult volume (P=0.15. The number of consults focusing on ophthalmic conditions, as a percentage of the yearly total, rose 460% (P=0.0001, while systemic condition consults with ocular manifestations fell 83% (P=0.0001. Consults for ocular trauma decreased 65% (P=0.0034. Consults ending with a

  17. Demonstration of “substantial research activity” to acquire consultative status under the Antarctic Treaty

    Directory of Open Access Journals (Sweden)

    Andrew D. Gray

    2016-12-01

    Full Text Available Antarctic Treaty Consultative Parties are entitled to participate in consensus-based governance of the continent through the annual Antarctic Treaty Consultative Meetings. To acquire consultative status, an interested Party must demonstrate “substantial research activity,” but no agreed mechanism exists to determine whether a Party has fulfilled this criterion. Parties have generally demonstrated substantial research activity with the construction of a research station, as suggested within the Treaty itself. However, this largely demonstrates logistical capacity, rather than research activity, and often results in major and persistent impacts on Antarctic terrestrial environments. Our study found that national investment in Antarctic infrastructure, estimated by the number of bed spaces at stations, was not a reliable indicator of scientific output. Therefore, we investigated metrics to evaluate research activity directly, and identified both the overall number of Antarctic papers and the proportion of national scientific output these represented as meaningful metrics. Such metrics could (1 demonstrate a nation's level of research activity in Antarctica or (2 help Consultative Parties assess the level of research activity undertaken by a Party seeking to acquire consultative status. Our data showed that, even without land-based Antarctic infrastructure, Canada, Denmark and Switzerland may have reasonable grounds to demonstrate “substantial research activity” on a level comparable with existing Consultative Parties. The use of these metrics may help dispel any perceived requirement for the establishment of a research station to reach consultative status, by putting a greater emphasis on generation of scientific research outputs rather than construction of Antarctic infrastructure.

  18. Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology

    Science.gov (United States)

    American Psychologist, 2007

    2007-01-01

    The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The…

  19. Consulting as a Strategy for Knowledge Transfer

    Science.gov (United States)

    Jacobson, Nora; Butterill, Dale; Goering, Paula

    2005-01-01

    Academic researchers who work on health policy and health services are expected to transfer knowledge to decision makers. Decision makers often do not, however, regard academics’ traditional ways of doing research and disseminating their findings as relevant or useful. This article argues that consulting can be a strategy for transferring knowledge between researchers and decision makers and is effective at promoting the “enlightenment” and “interactive” models of knowledge use. Based on three case studies, it develops a model of knowledge transfer–focused consulting that consists of six stages and four types of work. Finally, the article explores how knowledge is generated in consulting and identifies several classes of factors facilitating its use by decision makers. PMID:15960773

  20. Ground of maintenance of model of health of saving technologies of students of the special medical educational separation of physical education facilities

    Directory of Open Access Journals (Sweden)

    Prysjazhnuk S.I.

    2013-01-01

    Full Text Available The psychological pedagogical problems of physical development of students are considered with a rejection in a state of health. Experience of physical education of students of task medical force is studied. The structural functional model of process of physical education of students is developed with the use of health of saving technologies. Over 5000 students took part in researches. It is set that morphometric indexes are most closely associate. Intercommunications of indexes of level of development of physical qualities specify on insufficient differentiation in mechanisms which determine the structure of physical preparedness of students. Recommendations of model physical possibilities of students are resulted. Models are instrumental in an estimation individual potential possibility of organism. Models allow to utillize information for planning and leadthrough of a health educational educate process on physical education. Possibilities of determination of volume of the physical loading are shown taking into account a floor, nosology of diseases and state of physical preparedness of students.

  1. Mirror, mirror on the wall--evaluating Fair Market Value for manufacturer-physician consulting arrangements.

    Science.gov (United States)

    Eaton, Fred; Reid, Jaimee

    2010-01-01

    Pharmaceutical and medical device manufacturers contract with thousands of physicians each year, and struggle to comply with the Fair Market Value requirements of the Anti-Kickback Statute's "personal services" safe harbor. Consultant arrangements between physicians and manufactures have come under increasing scrutiny by regulators. In 2007, the five leading Hip & Knee manufacturers entered into settlement agreements related to their contract practices with physician consultants. Government sources do not provide guidance for calculating Fair Market Value; however, this article recommends four principles to use when evaluating Fair Market Value methodologies.

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

    Directory of Open Access Journals (Sweden)

    White KB

    2016-11-01

    Full Text Available Kathy B White,1 John Lee,2 Amanda C de C Williams3 1Central and North West London NHS Foundation Trust, 2School of Life and Medical Sciences, University College London, 3Research Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, London, UK 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

  3. Wind power projects and Aboriginal consultation

    Energy Technology Data Exchange (ETDEWEB)

    Isaac, T. [McCarthy Tetrault LLP, Vancouver, BC (Canada)

    2006-07-01

    This presentation outlined some of the legal aspects related to Aboriginal involvement in wind power development consultation processes and disputes. Aboriginal rights are rights held by Aboriginal people that are an element of a practice, custom, or tradition integral to the culture of groups claiming such rights. Wind power developers should understand that Aboriginal rights claims may include fishing; whaling; transportation; and cultural and spiritual activities. Aboriginal title is a subcategory of Aboriginal rights, and is a right to land itself, and an encumbrance on the Crown's underlying title to land. Weak Aboriginal claims where potential infringement by energy developers is minor may only require notice and information. Strong prima facie cases for Aboriginal rights and title where the potential for infringement is of high significance may result in more extensive consultation involving interim solutions; formal Aboriginal participation in decision-making processes; and written responses demonstrating how Aboriginal concerns have been considered. There are a number of circumstances requiring a case-by-case approach, and the Crown may make decisions in the face of Aboriginal disagreement. However, energy developers should ensure that consultation processes are fair and reasonable. Conflicting interests can often be successfully resolved through consultation, and accommodation to Aboriginal rights may include mitigation, avoiding interference, and agreeing to as little infringement as possible. Aboriginal title may attach to private land but only to the Crown's underlying title. The Crown has no duty to consult respecting Aboriginal title on private land because title has already been infringed. In these cases, duty to consult and accommodate may be discharged through other regulatory processes such as environmental impact assessments. It was concluded that wind power project proponents should build a relationship with the Crown, as avoiding

  4. Moral mediation in interpreted health care consultations.

    Science.gov (United States)

    Seale, Clive; Rivas, Carol; Al-Sarraj, Hela; Webb, Sarah; Kelly, Moira

    2013-12-01

    This paper reports on the moral work done in routine diabetes review consultations in primary care with nurses. Consultations with fluent English speakers are compared with consultations where an interpreter was present, largely involving patients of Bangladeshi origin. The study setting was Tower Hamlets in London, where type 2 diabetes is particularly common. Existing research has shown some dissatisfaction with diabetes care amongst Bangladeshi patients, and studies of care providers in other locations suggest that they at times experience the care of this group as particularly challenging. Through analysis of video-recorded consultations recorded in 2010-2011 we shed light on possible reasons for these difficulties. The 12 non-English speakers often experienced difficulties in raising issues that concerned them, particularly if their interpreter did not translate their utterance because it was deemed to be unrelated to diabetes. These difficulties were not shared by the 24 fluent English speakers, who also found it easier to convey a positive moral reputation and to excuse behaviour that deviated from recommended self-management practices. Interpreters at times also acted as moral mediators. For example, where a participant in the consultation made statements that appeared to convey a negative moral judgement of an other participant, these would often go untranslated. Probably, neither health care providers nor patients are fully aware of the nature of their communication difficulties. Given this, interpreters possess considerable power to influence matters. Understanding the moral work of consultations is important in explaining the findings of other studies showing difficulties in the provision of diabetes care to people with limited English language skills.

  5. Keeping morality out and the GP in. Consultations in Danish general practice as a context for smoking cessation advice

    DEFF Research Database (Denmark)

    Guassora, Ann Dorrit; Tulinius, Anne Charlotte

    2008-01-01

    OBJECTIVE: To describe consultations in Danish general practice as a context for a mass strategy of smoking cessation advice. METHODS: The focus of the study was on consultations for health problems that were not related to smoking. Interviews with eleven patients and their six GPs were grounded...... in observation of their own consultations. RESULTS: Patients and GPs agreed that the GP should adopt an attitude of moral acceptance towards patients. Ideals of moral acceptance of patients in general practice consultations were challenged by the prevailing negative moral values associated with smoking...... based on motivational interviewing would fit in the context of Danish general practice. Relieving the conversation of blocks due to moral implications, however, is still a challenge....

  6. Standardization Versus Innovation In Management Consultancy

    Directory of Open Access Journals (Sweden)

    Ciumara Tudor

    2011-12-01

    Full Text Available This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD, financed from the European Social Fund and by the Romanian Government under the contract number SOP HRD/89/1.5/S/62988. In this paper we propose some perspectives on the relationship between standardization and innovation in the management consulting business. Most of the consulting services are situated somewhere between absolute standardization and absolute innovation. Approaching any of these poles brings some advantages and disadvantages, both to the service providers and to their customers. It is important to find a balance between innovation and standardization to maximize the results of all agents involved.

  7. Asthma consultations with specialists: what do the pediatricians seek?

    Science.gov (United States)

    Poowuttikul, Pavadee; Kamat, Deepak; Thomas, Ronald; Pansare, Milind

    2011-01-01

    "Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma" includes guidelines for referral to an asthma specialist. Because most cases of asthma are managed by primary care physicians, we intended to explore the referral practices of pediatricians managing childhood asthma. This study was designed to identify important considerations by pediatricians while referring a child to an asthma specialist. An electronic survey was sent to 1200 graduated pediatricians enlisted in the Michigan Chapter, American Academy of Pediatrics directory. The questions explored asthma disease characteristics, physician preferences when referring children with asthma, and reasons and barriers for asthma consultations. All responses were collected anonymously. We received 240/1200 (20%) questionnaires. The majority of pediatricians considered referral to a specialist if a child had severe persistent asthma (201/236 [85.2%]) or had a single life-threatening asthma event (188/229 [82.1%]). The top two likely reasons of referral included poor asthma control (200/224 [89.3%]) and unclear diagnosis (139/224 [62.1%]). We found 74/219 (33.8%) preferred consultation to a pediatric pulmonologist when compared with 93/219 (42.5%) allergists. We found the minority of pediatricians "always" recommended referral to a specialist for the following reasons: allergy skin testing (30/222 [13.5%]), possible allergen immunotherapy (54/223 [24.2%]), and spirometry (26/221 [11.8%]). The major barrier for childhood asthma specialist consultations was issues with medical insurance coverage (137/205 [66.8%]). Allergists have to educate primary care providers about the importance of allergen control, role of allergen immunotherapy, and updating current asthma treatment guidelines when treating a child with allergic asthma.

  8. The use of shared medication record as part of medication reconciliation at hospital admission is feasible

    DEFF Research Database (Denmark)

    Munck, Lars K; Hansen, Karina R; Mølbak, Anne Grethe

    2014-01-01

    INTRODUCTION: Medication reconciliation improves congruence in cross sectional patient courses. Our regional electronic medical record (EMR) integrates the shared medication record (SMR) which provides full access to current medication and medication prescriptions for all citizens in Denmark. We...... studied whether our SMR integration could facilitate medication reconciliation. MATERIAL AND METHODS: Patients admitted to the emergency department for hospitalization were randomised to consultation using EMR with or without the integrated SMR access. Observed time used for medication reconciliation...... was the primary efficacy parameter. RESULTS: A total of 62 consecutive patient consultations were randomised including 39 with more than five prescriptions. EMR had data from previous consultations for 46 patients, 59 patients provided information on medication. In all, 18 junior physicians in early postgraduate...

  9. Framing the consultation: the role of the referral in surgeon-patient consultations.

    Science.gov (United States)

    White, Sarah J; Stubbe, Maria H; Macdonald, Lindsay M; Dowell, Anthony C; Dew, Kevin P; Gardner, Rod

    2014-01-01

    This study describes and analyzes the impact of the referral process on communication at the beginning of surgeon-patient consultations. We used conversation analysis to analyze the opening interactional activities of surgeon-patient consultations in New Zealand. This study focuses on 20 video-recorded consultations recorded between 2004 and 2006. Participants in surgeon-patient consultations began referred consultations by discussing the referral letter in what we have termed "referral recognition sequences." These sequences are coconstructed activities that can be implicit or explicit and address the minimized epistemic distance between surgeons and patients that is caused by the referral process. These sequences can be simple or complex, and this complexity may be determined by the quality of the referral letter received. Acknowledgment of the referral letter assists in achieving alignment between surgeon, patient, and referring doctor regarding the presenting problem. If this alignment is not achieved, progressivity of the consultation is affected, as there is disagreement as to why the patient is seeing the surgeon. This research shows that to assist in the progressivity of surgeon-patient consultations, referral letters should be clear and patients made aware of the reason for referral. Surgeons should also overtly address the minimized epistemic distance caused by the referral letter to ensure patients present their problems in full.

  10. Quality Management in Project Management Consulting. A Case Study in an International Consulting Company

    Directory of Open Access Journals (Sweden)

    Eduard-Gabriel Ceptureanu

    2017-02-01

    Full Text Available The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the most important aspects of the consulting activity on which depend the achievement of the project aims, there is scope for further investigating this subject. Here, the case of a project management consulting organization involved in large infrastructure projects in Romania, Bulgaria, Moldova, Ukraine and Serbia is analyzed. Data collected through a questionnaire-based survey among international consultants and support personnel suggest that factors related to leadership style and communication skills are more closely tied to the success of the project than more technical aspects. The results constitute an empirical evidence of main success factors for specialized consulting services in project management and can be useful in improving business and project performance and achieving business excellence.

  11. Lung cancer physicians' referral practices for palliative care consultation.

    Science.gov (United States)

    Smith, C B; Nelson, J E; Berman, A R; Powell, C A; Fleischman, J; Salazar-Schicchi, J; Wisnivesky, J P

    2012-02-01

    Integration of palliative care with standard oncologic care improves quality of life and survival of lung cancer patients. We surveyed physicians to identify factors influencing their decisions for referral to palliative care. We provided a self-administered questionnaire to physicians caring for lung cancer patients at five medical centers. The questionnaire asked about practices and views with respect to palliative care referral. We used multiple regression analysis to identify predictors of low referral rates (consultation. Multivariate analysis, controlling for provider characteristics, found that low referral rates were associated with physicians' concerns that palliative care referral would alarm patients and families [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.21-0.98], while the belief that palliative care specialists have more time to discuss complex issues (OR 3.07, 95% CI 1.56-6.02) was associated with higher rates of referral. Although palliative care consultation is increasingly available and recommended throughout the trajectory of lung cancer, our data indicate it is underutilized. Understanding factors influencing decisions to refer can be used to improve integration of palliative care as part of lung cancer management.

  12. Sustainability of a proactive geriatric trauma consultation service.

    Science.gov (United States)

    Wong, Camilla L; Al Atia, Raghda; McFarlan, Amanda; Lee, Holly Y; Valiaveettil, Christina; Haas, Barbara

    2017-02-01

    Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012-December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.

  13. Hospitalized hunger-striking prisoners: the role of ethics consultations.

    Science.gov (United States)

    Caenazzo, Luciana; Tozzo, Pamela; Rodriguez, Daniele

    2016-12-01

    We refer to hospitalized convicted hunger strikers in Padua Hospital who decided to fast for specific reasons, often demanding, to be heard by the judge, to complain about the existing custodial situation or to claim unjust treatment. The medical ethics of hunger strikers are debated because the use of force feeding by physicians is widely condemned as unethical, but courts, in Italy, sometimes order to transfer the convicted person to hospital and oblige healthcare practitioners to perform forcible feeding. This can engender a profound insecurity for the physicians taking action on the one hand, while preventing patients from fully availing themselves of this principle of self-determination on the other. Physicians are mainly concerned about how to manage this situation and they may request ethical consultation. When it comes to managing hospitalized hunger strikers, the ethics consultant may be able to facilitate the relationship between physicians and hunger strikers, enhance the latter's trust in the former, ensuring that strikers are aware of the risks associated with their fasting, and helping them to arrive of their own free will at the right decision concerning their behavior and their demands.

  14. Why do Chinese Canadians not consult mental health services: health status, language or culture?

    Science.gov (United States)

    Chen, Alice W; Kazanjian, Arminée; Wong, Hubert

    2009-12-01

    Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.

  15. Lessons learned in pilot testing specialty consultations to benefit individuals with lower limb loss.

    Science.gov (United States)

    Elnitsky, Christine; Latlief, Gail; Gavin-Dreschnack, Deborah; Harris, Melanie; Campbell, Robert

    2012-01-01

    Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program. Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.

  16. Lessons Learned in Pilot Testing Specialty Consultations to Benefit Individuals with Lower Limb Loss

    Directory of Open Access Journals (Sweden)

    Christine Elnitsky

    2012-12-01

    Full Text Available Telerehabilitation technologies enable the delivery of rehabilitation services from providers to people with disabilities as well as specialty care consultations. This article discusses the barriers experienced when planning and pilot testing a telerehabilitation multi-site specialty consultation for specialists in their medical centers, and the lessons learned. The barriers included integration and participation, coordination across organizational units, and privacy and information security. Lessons learned included the need for collaboration across multiple departments, telerehabilitation equipment back-ups, and anonymous and private communication protocols. Despite delays resulting from coordination at multiple levels of a national organization, we developed a program plan and successfully implemented a pilot test of the southeast region program.  Specialty consultation using telerehabilitation delivery methods requires identifying provider preferences for technological features. Lessons learned could inform development of outpatient telerehabilitation for patients with amputations and studies of patients and providers involved in telerehabilitation.

  17. Consultation performance of general practitioners when supported by an asthma/COPDC-service

    Directory of Open Access Journals (Sweden)

    Annelies Lucas EM

    2012-07-01

    Full Text Available Abstract Background General practitioners (GPs can refer patients to an asthma/COPD service (AC-service for diagnostic assessment of spirometry and medical history and for asthma or COPD monitoring. The AC-service reports diagnostic results and additional information about disease burden (BORG-score for complaints, MRC-dyspnoea score, exacerbation rate, life style, medication and compliance, to the patient’s GP. This study explores how GPs use this additional information when discussing the patient’s disease burden and how this influences GPs’ information and education provision during consultations with asthma/COPD patients. Method Patients with (a suspicion of asthma or COPD were referred to an AC-service and consulted their GPs after they had received a report from the AC-service. Retrospectively patients answered questions about their GPs’ performance during these consultations. Performances were compared with performances of the same GPs during consultations without support of the AC-service (usual care, earlier that year. Results Of consultations not initiated by an AC-service check-up, 91% focussed on complaints, the initial reason for the consultation. In AC-service supported follow-up consultations, GPs explored disease burden when the (BORG-score for complaints was high - as reported by the AC-service - even when patients themselves thought it was irrelevant. GPs put significantly less effort in exploring disease burden when the Borg-score was low (BORG 3–4: 69%; BORG1-2: 51%, p = 0,01. GPs mostly ignored MRC-dyspnoea scores: attention to dyspnoea was 18% for MRC-score p = 0,63. GPs encouraged physical fitness in 13% of patients. Smoking behaviour was discussed with 66% of the actual smokers but only 14% remembered a stop smoking advice. Furthermore, pharmacotherapeutic management education in AC-service supported consultations did not differ from performance in usual care according to patient evaluations. Conclusion

  18. Negotiating the Dance: Consulting with Adoptive Systems.

    Science.gov (United States)

    Becker, Kent W.; Carson, David K.; Seto, Atsuko; Becker, Carol A.

    2002-01-01

    For marriage and family therapists and educators who train future marriage and family therapists, families formed by means of adoption offer an abundance of learning opportunities in both the areas of assessment and intervention. The following consultation case represents a composite family designed to highlight the unique features of adoptive…

  19. Delivering an MBA Management Consulting Experience

    Science.gov (United States)

    LeMaire, Ryan; Fisher, Kirk; Watson, Edward F., III

    2017-01-01

    This article reports on an innovative MBA elective consulting course that attempts to address how to better prepare inexperienced MBA students for a competitive job market. This article is a best practice paper designed to provide insights and encouragement to educators.

  20. School Neuropsychology Consultation in Neurodevelopmental Disorders

    Science.gov (United States)

    Decker, Scott L.

    2008-01-01

    The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

  1. Science Consultants, Fictional Films, and Scientific Practice.

    Science.gov (United States)

    Kirby, David A.

    2003-01-01

    Proposes films to be successful communicative devices within the scientific community by showing that other scientists respond to depictions in films and how they respond. Demonstrates that science consultants use fictional films as promotional devices for their research fields. (Author/NB)

  2. Individualizing Language Strategies Using CONSULT-I.

    Science.gov (United States)

    Newman, Anabel P.; Metz, Elizabeth

    This handbook offers suggestions for implementing actions (termed variously in other settings as treatments, interventions, methods, techniques, strategies or activities) recommended for individual learners by CONSULT-I (R), a computer program created by James Fattu and Edward Patrick. Application of the program described in the handbook was under…

  3. 76 FR 55678 - Tribal Consultation Policy

    Science.gov (United States)

    2011-09-08

    ... proposal, new rule adoption, and other policy changes) that cause ACF to consult with the tribes. ACF's..., including native americans, persons with developmental disabilities, refugees, and legal immigrants, to help... budget (OLAB). Office of planning, research and evaluation (opre). Office of refugee resettlement (ORR...

  4. The Writing Consultation: Developing Academic Writing Practices

    Science.gov (United States)

    Murray, Rowena; Thow, Morag; Moore, Sarah; Murphy, Maura

    2008-01-01

    This article describes and analyses a specific mechanism, the writing consultation, designed to help academics to prioritise, reconceptualise and improve their writing practices. It makes the case for its potential to stimulate consideration of writing practices and motivations, a possible precondition for creating time for writing in academic…

  5. IT Consultants in Acquisition IT Integration

    DEFF Research Database (Denmark)

    Henningsson, Stefan; Øhrgaard, Christian

    2016-01-01

    model, depicting the use of external consultants in acquisition IT integration, contributes to the literature on acquisition IT integration by providing an explanation for IT-based value creation in acquisition that is rooted in the external of the acquirer. In addition to adding to the limited...

  6. Service Learning In Physics: The Consultant Model

    Science.gov (United States)

    Guerra, David

    2005-04-01

    Each year thousands of students across the country and across the academic disciplines participate in service learning. Unfortunately, with no clear model for integrating community service into the physics curriculum, there are very few physics students engaged in service learning. To overcome this shortfall, a consultant based service-learning program has been developed and successfully implemented at Saint Anselm College (SAC). As consultants, students in upper level physics courses apply their problem solving skills in the service of others. Most recently, SAC students provided technical and managerial support to a group from Girl's Inc., a national empowerment program for girls in high-risk, underserved areas, who were participating in the national FIRST Lego League Robotics competition. In their role as consultants the SAC students provided technical information through brainstorming sessions and helped the girls stay on task with project management techniques, like milestone charting. This consultant model of service-learning, provides technical support to groups that may not have a great deal of resources and gives physics students a way to improve their interpersonal skills, test their technical expertise, and better define the marketable skill set they are developing through the physics curriculum.

  7. 77 FR 19020 - Tribal Consultation Meeting

    Science.gov (United States)

    2012-03-29

    ... Act of 2007, Public Law 110-134, notice is hereby given of a one-day Tribal Consultation Session to be... into consideration funding allocations, distribution formulas, and other issues affecting the delivery... children and families, taking into consideration funding allocations, distribution formulas, and...

  8. 29 CFR 1691.12 - Interagency consultation.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 4 2010-07-01 2010-07-01 false Interagency consultation. 1691.12 Section 1691.12 Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION PROCEDURES FOR COMPLAINTS OF...) Prior to the initiation of any legal action against a recipient of Federal financial assistance alleging...

  9. Teacher Utilization of Instructional Consultation Teams

    Science.gov (United States)

    Berger, Jill; Yiu, Ho Lam; Nelson, Deborah; Vaganek, Megan; Rosenfield, Sylvia; Gravois, Todd; Gottfredson, Gary; Vu, Phuong; Shanahan, Kate; Hong, Vanessa

    2014-01-01

    Data regarding intervention utilization among the target population are critical to interpret evidence from efficacy trials for school-based interventions. When use of the intervention is voluntary, intervention diffusion becomes a particularly critical variable. We examined the use of Instructional Consultation Teams (IC Teams), a voluntary…

  10. The representations of adolescents about gynecological consultation

    Directory of Open Access Journals (Sweden)

    Vera Lúcia de Oliveira Gomes

    2014-06-01

    Full Text Available Objective: To analyze the social representation of adolescents about gynecological consultation and the influence of those in searching for consultations. Method: Qualitative descriptive study based on the Social Representations Theory, conducted with 50 adolescents in their last year of middle school. The data was collected between April and May of 2010 by Evocations and a Focal Group. The software EVOC and contextual analysis were used in the data treatment. Results: The elements fear and constraint, constant in the central nucleus, can justify the low frequency of adolescents in consultations. The term embarrassment in the peripheral system reinforce current sociocultural norms, while prevention, associated with learning about sex and clarifying doubts, allows to envision an educative function. Obtained testimonies in the focal groups exemplify and reinforce those findings. Conclusion: For an effective health education, professionals, including nurses, need to clarify the youth individually and collectively about their rights to privacy, secrecy, in addition to focus the gynecological consultation as a promotion measure to sexual and reproductive health.

  11. The Role of the Organisational Development Consultant

    Science.gov (United States)

    Simmons, Mike

    1972-01-01

    The consultant's concern is to increase an organization's capacity to initiate and manage change through an integrated approach to the company's social, economic, technical, and organizational systems, and to improve the performance and value of its human resources, using measurable criteria whenever possible. (Author/JB)

  12. Viburnum “terugloopziekte” : Consultancy onderzoek

    NARCIS (Netherlands)

    Ludeking, D.J.W.; Kromwijk, J.A.M.; Boer-Tersteeg, de P.M.; Bosch, C.

    2012-01-01

    DUTCH Bij de teelt van Viburnum opulus komt het soms voor dat de groei pleksgewijs langzaam terugloopt. Het gewas lijkt niet ziek, maar het blad wordt stug en donker en de taklengte en bladgrootte worden elk jaar kleiner. In dit consultancy onderzoek is onderzocht wat de oorzaak is van deze

  13. The Writing Consultation: Developing Academic Writing Practices

    Science.gov (United States)

    Murray, Rowena; Thow, Morag; Moore, Sarah; Murphy, Maura

    2008-01-01

    This article describes and analyses a specific mechanism, the writing consultation, designed to help academics to prioritise, reconceptualise and improve their writing practices. It makes the case for its potential to stimulate consideration of writing practices and motivations, a possible precondition for creating time for writing in academic…

  14. School Neuropsychology Consultation in Neurodevelopmental Disorders

    Science.gov (United States)

    Decker, Scott L.

    2008-01-01

    The role of school psychologists with training in neuropsychology is examined within the context of multitiered models of service delivery and educational reform policies. An expanded role is suggested that builds on expertise in the assessment of neurodevelopmental disorders and extends to broader tiers through consultation practice. Changes in…

  15. Psychiatric consultation of patients with hyperemesis gravidarum.

    Science.gov (United States)

    Kim, Deborah R; Connolly, K R; Cristancho, Pilar; Zappone, Mark; Weinrieb, Robert M

    2009-04-01

    The request for a psychiatric examination of patients with hyperemesis gravidarum (HG) is a unique challenge for the psychiatric consultant. Unfortunately, there are little data in the psychosomatic medicine literature to guide diagnostic evaluations and treatment of patients with HG. In this article, we summarize the existing literature and propose a practical approach to such patients based on the literature and our clinical experience.

  16. 34 CFR 200.63 - Consultation.

    Science.gov (United States)

    2010-07-01

    ... children from low-income families residing in participating public school attendance areas, including... to teachers and families of participating private school children. (c)(1) Consultation by the LEA... Programs Operated by Local Educational Agencies Participation of Eligible Children in Private Schools §...

  17. The Role of Ethics Committees and Ethics Consultation in Allocation Decisions

    Science.gov (United States)

    Strech, Daniel; Hurst, Samia; Danis, Marion

    2013-01-01

    Background Decisions about the allocation and rationing of medical interventions likely occur in all health care systems worldwide. So far very little attention has been given to the question of what role ethics consultation and ethics committees could or should play in questions of allocation at the hospital level. Objectives and Methods This article argues for the need for ethics consultation in rationing decisions using empirical data about the status quo and the inherent nature of bedside rationing. Subsequently, it introduces a 4-stage process for establishing and conducting ethics consultation in rationing questions with systematic reference to core elements of procedural justice. Results Qualitative and quantitative findings show a significant demand for ethics consultation expressed directly by doctors, as well as additional indirect evidence of such a need as indicated by ethically challenging circumstances of inconsistent and structurally disadvantaging rationing decisions. To address this need, we suggest 4 stages for establishing and conducting ethics consultation in rationing questions we recommend: (1) training, (2) identifying actual scarcity-related problems at clinics, (3) supporting decision-making, and (4) evaluation. Conclusion This process of ethics consultation regarding rationing decisions would facilitate the achievement of several practical goals: (i) encouragement of an awareness and understanding of ethical problems in bedside rationing, (ii) encouragement of achieving efficiency along with rationing, (iii) reinforcement of consistency in inter- and intraindvidual decision-making, (iv) encouragement of explicit reflection and justification of the prioritization criteria taken into consideration, (v) improvement in internal (in-house) and external transparency, and (vi) prevention of the misuse of the corresponding consulting structures. PMID:20706163

  18. Two years of psychogeriatric consultations in a nursing home: reasons for referral compared to psychiatrists' assessment

    Directory of Open Access Journals (Sweden)

    Costantini Chiara

    2006-06-01

    Full Text Available Abstract Background In spite of the high prevalence of psychiatric disorders among elderly residents in nursing homes, only a small number of patients in need of specialist care are referred to a psychiatric consultant. The aim of this research was to evaluate the consultation activity and the appropriateness of referral to psychiatric assessment. Methods Data were collected and analysed on consultation carried out over a two-year period in a RSA (Residenza Socio-Assistenziale in Northern-Italy. Data were catalogued with reference to: patients, consultation, diagnosis and recommended medications. Statistical correlation analysis by means of Spearman test and signification test was carried out. Results Residents referred to psychiatric consultation at least once were 112 (14.5% of all residents. Reason for referral were: depression (17.2%, delusions and hallucinations (14%, agitation (34.8%, aggressive behaviour (23.5% and disturbances of sleep (6.8%. Most frequent diagnoses were organic, including symptomatic, mental disorders (33.9%, mood disorders (22.3% and schizophrenia, schizotypal and delusional syndromes (18.8%. No psychiatric diagnosis was found only in 1.8% of cases, thus confirming high sensibility of referring physicians. A statistically significant correlation was found when comparing referrals for depression or delusions and allucinations or sleep disturbances and diagnostic confirmation of such symptoms by specialistic assessment (respectively 49.8%, 52.7% and 19.6%. Correlation between psychotic symptoms and the consequent prescription of antipsychotic drugs had a significant if somewhat modest value (24% while correlation between depression symptoms and prescription of antidepressant drugs was more noticeable (66.5%. Conclusion Main reason for referral to psychiatric consultation resulted to be the presence of agitation, a non-specific symptom often difficult to attribute. Data concerning depression confirm tendency to

  19. [Consultation skills training as an element of general practice training in Germany - a qualitative survey].

    Science.gov (United States)

    Nittritz, Christine; Schaffer, Susann; Kühlein, Thomas; Roos, Marco

    2016-11-01

    The consultation is at the heart of general practice. It is the central setting through which primary care is delivered. The competency requirements are laid down internationally by competency-based curricula for undergraduate and postgraduate education. So far, there is no competency-based vocational training to develop consultation skills in general practice in Germany. The study describes experiences with consultation skills training as an element of general practice training as reported by trainees and trainers in Germany. A qualitative and exploring approach was chosen because there is little experience with the German situation. We conducted structured focus group interviews with trainees and trainers, respectively. We recruited all participants by e-mail via the mail distributor "Junge Allgemeinmedizin Deutschland" (JADE, a trainee and junior GP organization) and the academic teachers of the Friedrich-Alexander University Erlangen-Nürnberg. Altogether, four focus group interviews with three to five participants were conducted, varying in length from 25 to 65minutes. All interviews were recorded digitally and transcribed verbatim. Then a qualitative content analysis was performed. The statements of the ten trainees and five trainers mapped a system of four main categories: (a) association with the term consultation, (b) parts of a consultation, (c) competencies required for professional practice, (d) consultation skills training as an element of vocational training. Overall, all participants regarded the consultation as the most important element in general practice. Important content of consultations is to build a relationship with the patient, gather information, conduct physical examinations and achieve informed consent on further proceedings. All participants agreed that physicians need different sets of competencies: medical expertise, communication skills, examination skills and professionalism. Finally, there was a broad consensus that a competency

  20. The Role of a Hospital Ethics Consultation Service in Decision-Making for Unrepresented Patients.

    Science.gov (United States)

    Courtwright, Andrew M; Abrams, Joshua; Robinson, Ellen M

    2017-03-06

    Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment (LST) for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013. There were 310 ethics committee consultations, twenty-five (8.1 per cent) of which involved unrepresented patients. In thirteen (52.0 per cent) cases, the ethics consultants evaluated a possible substitute decision-maker identified by social workers and/or case managers. In the remaining cases, the ethics consultants worked with the medical team to contact previous healthcare professionals to provide substituted judgement, found prior advance care planning documents, or identified the patient's best interest as the decision-making standard. In the majority of cases, the final decision was to limit or withdraw LST (72 per cent) or to change code status to Do Not Resuscitate/Do Not Intubate (12 per cent). Substitute decision-makers who had been evaluated through the ethics consultation process and who made the final decision alone were more likely to continue LST than cases in which physicians made the final decision (50 per cent vs 6.3 per cent, p = 0.04). In our centre, the primary role of ethics consultants in decision-making for unrepresented patients is to identify appropriate decision-making standards. In the absence of other data suggesting that ethics committees, as currently constituted, are ready to serve as substitute decision-makers for unrepresented patients, caution is necessary before designating these committees as default decision-makers.

  1. Impact of the nursing consultation in the External Fixatives Clinic of National Children Hospital

    Directory of Open Access Journals (Sweden)

    Virginia Salas Cerdas

    2013-04-01

    Full Text Available This article presents the results of a study which analyzed 10 cases (8 female and 2 male aged betweentwo and 17 years, with a number of bone defects, and conducted over a period of three months in the externalfixator Clinic National Children's Hospital. Aimed to provide a clear vision about the need of this pediatricpopulation to have a consultation with Clinical Nursing. The exploratory study was conducted using anobservation guide and interviews with users, parents and interdisciplinary team, and implemented the nursingsegmented into three stages: pre-consultation, consultation and post-consultation, evaluating each the problemsand needs of each user (a, as well as the achievements of the children in this research and the role played by thenurse in the consultations. The results show specifically the educational aspects in physical and emotional healthnurse that gave the users and their families and at-hospital benefits through the implementation of the nursing. Weconclude that children participating in the study achieve proper assimilation and implementation of healtheducation regarding: skin healing fixer, signs and symptoms of infection, operation keys, administration ofantibiotics, plaster care and healthy food choices. In addition, awareness was achieved in children and theirparents in monitoring medical indications allowing satisfactory results in treatment.

  2. [Motives of requirement for health care consultations and factors associated to mortality due to poisoning].

    Science.gov (United States)

    Villa-Manzano, Alberto Iram; Lamas-Flores, Sofía; Méndez-Cervantes, Diana; Villa-Manzano, Rebeca; Cabrera-Pivaral, Carlos E; Rojo-Contreras, Wendoline

    2009-01-01

    The poisoning is a public health problem. This problem requires continuous evaluation to decrease it. Our objective was to identify causes of requirement for health care consults and factors associated to mortality due to poisoning. We assessed the requirements for health care consults during one year and the outcomes of these consultations in a center of toxicology. Odds ratios (OR) were used as risk estimator. There were 3116 consultations due to poisons. From these 79% required hospitalization. The identified causes were: be bite and wound inflected by poisonous animals in 57 % (44 % of these were due to scorpions); medications in 15 %; agrochemicals in 5 % and in 4 % prohibit substances (marihuana or cocaine). A poisoning caused by suicidal attempt was observed in 28 %. Mortality rate was 3/1000, and the mortality rate for suicidal attempt was 0.7 % meaning an OR = 6 (95 % CI = 1.3 to 31) compared with the overall mortality rate. The most frequent cause of mortality was organophosphorates poisoning (OR = 30, 95 % CI = 2.86-759). The poisoning secondary to animals represented the most frequent cause for consultation. The suicidal attempt and organophosphorates intoxication were associated with higher mortality.

  3. Medical Service Information

    CERN Multimedia

    GS Department

    2010-01-01

    The Medical Service is pleased to inform you that a psychologist specialising in psychotherapy (member of the Swiss Federation of Psychologists- FSP), Mrs Sigrid Malandain, will be starting work at the CERN on 1 November 2010, in the premises of the Medical Service, Building 57-1-024. Members of CERN personnel can request individual consultations, by appointment, in French or in English, on Tuesdays and Thursdays by calling 78435 (Medical Service secretariat) or sending an e-mail to psychologist-me@cern.ch.

  4. Videoconference as a tool for European interhospital consultations in radiology

    Science.gov (United States)

    Bartsch, Frank-Reinhard; Gerneth, Marlene; Schosser, Rudolf

    1993-10-01

    In the frame of the EC-sponsored TELEMED project, videoconferencing was evaluated as a tool for Remote Expert Consultation (REC) in radiology. The REC environment has been established as a pan-European demonstrator for advanced telecommunication applications in medicine. Five European university hospitals have been interconnected using broadband networks at a speed of 2 Mbit/s and 140 Mbit/s. Videoconference was evaluated in more than 120 sessions. In the experiments, videoconference proved to be a useful tool for teleconsultations, providing a set of requirements identified as indispensable for medical videoconference such as remotely adjustable iris for the document camera are fulfilled. Diagnostic reliability of images recorded with our equipment proved acceptable for digitally acquired images while reliability is limited for conventional images with a high demand of spatial and contrast resolution. Regional spin-off applications that have been established at some participating sites underline the potential of videoconference in health care.

  5. Factors affecting consultation length in a Japanese diabetes practice.

    Science.gov (United States)

    Kabeya, Yusuke; Uchida, Junko; Toyoda, Masao; Katsuki, Takeshi; Oikawa, Yoichi; Kato, Kiyoe; Kawai, Toshihide; Shimada, Akira; Atsumi, Yoshihito; Higaki, Megumu

    2017-04-01

    Sufficient consultation time is important for establishing good doctor-patient relationship. We examined the factors that affect consultation length in Japanese diabetes practice. This was a cross-sectional study performed at a diabetes clinic in central Tokyo, Japan. Regular diabetes consultations of 1197 patients with 22 physicians were analyzed. Consultation time and clinical characteristics were obtained from the electronic records. A negative binomial model, which included patient and physician characteristics, was constructed to examine the association of the variables with consultation length. Of the 1197 patients (mean age, 66; women, 25%; type 1 diabetes, 10%), the mean consultation time was 10.1min. In the multivariate model, longer consultation time was recorded in patients with type 1 diabetes, higher glycated hemoglobin (HbA1c), use of insulin injections, and use of hypnotics/anxiolytics. The consultation time was longer in patients with HbA1c of ⩾7.0 to consultation. Older and female physicians provided longer consultation. Clinical consultation length in diabetes practice was associated with certain patient and physician characteristics. The findings can be used for making diabetes consultation more efficacious, which could eventually lead to the provision of the most appropriate consultation time for individual patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. The Evaluation of Psychiatry Consultation Requested in a University Hospital

    Directory of Open Access Journals (Sweden)

    Hasan Mayda

    2016-01-01

    Full Text Available Aim: The objective of our study was to evaluate the socio-demegraphic data, psychiatric diagnosis according to Diagnostic and Statistical Manuel of Mental disorder (DSV-IV of patients, referral rates of medical and surgical clinics and reasons for referrals in inpatients who were requested psychiatry consultationb Material and Method: This study was conducted in Afyonkarahisar, in a 530 bed university hospital. For a period of six months, a retrospective data was collected from 124 inpatients who were requested psychiatric consultations. Psychiatric diagnoses were based on DSM-IV. Results: Ižndicated that mean age of patients are 50.1±19.7%u2019di. Seventy (56.5% patients were female and 54 (43.5% of patients were male. The most frequent referral clinics were internal medicine (24.2%, followed by neurology (14.5% and physical medicine (14.5% and rehabilitation (11.3% The most frequent reasons for referral were depressive symptoms (21.8% somatic complaint (17.7%, agitation and non-compliance to treatment (16.1% and suicidal attempted (10.5%. Psychopathology was determined in majority of patients (86.3%. Regarding the psychiatric diagnosis, adjustment disorders (21 % were the most common. Discussion: The interaction between psychiatry and other medical clinical is important because of psychiatric disorders are more commonly seen among medical and surgical inpatients.

  7. Consultations in primary care for symptoms attributed to electromagnetic fields – a survey among general practitioners

    Directory of Open Access Journals (Sweden)

    Röösli Martin

    2006-10-01

    Full Text Available Abstract Background Five percent of the Swiss population attribute symptoms to electromagnetic fields (EMF. General practitioners (GPs might play a key role in recognising an emerging health risk, since they are the first to observe and follow up persons who attribute symptoms to EMF. It is unclear to what extent EMFs have become an issue in general practice and which experiences GPs report from the consultations. Methods We conducted telephone interviews in a random sample of GPs in Switzerland in order to assess the frequency of consultations in primary care due to EMF and the GPs' experience with these patients. Results 342 general practitioners were interviewed, corresponding to a response rate of 28.2%. 69% of the GPs reported at least one consultation due to EMF, but GPs with a certificate in complementary medicine were much more likely to report EMF consultations. The median of EMF consultation numbers within one year was three. An overview of the most recent EMF-related consultation per GP yielded sleep disorders, headaches and fatigue as the most often reported symptoms and mobile phone base stations, power lines and the own use of mobile phones as the main EMF sources suspected to be associated to symptoms. GPs judged the association between EMF and the symptoms to be plausible in 54% of the cases. There was no combination of symptoms and EMF sources that was remarkably and consistently judged to be a plausible cause of the symptoms. Conclusion In our survey, GPs often judged the association between the health problems and the suspected exposure to be plausible. This plausibility assessment seems to be based on grounds of preventive positions in a situation of scientific uncertainty. More research effort is needed to obtain more insight on a potential association between long term EMF exposure and unspecific symptoms.

  8. Médicos, pacientes y consultorios: Un abordaje etnográfico de las consultas médicas en la atención del VIH/Sida Médicos, pacientes e consultórios: Um abordagem etnográfico das consultas médicas na atenção do HIV/Aids Doctors, patients and practices: An ethnographic approach to medical consultations in HIV/AIDS treatment and care

    Directory of Open Access Journals (Sweden)

    María Laura Recoder

    2011-06-01

    Full Text Available En este trabajo se describen y analizan situaciones de interacción producidas en el curso de consultas clínico-infectológicas en la atención de personas que viven con VIH/Sida. Son interacciones que dan lugar a procesos interpretativos que operan en la construcción de la enfermedad y las experiencias de cuidado de los afectados. El análisis de las miradas, los gestos, las pausas y las palabras nos permiten comprender parte de las relaciones de poder, la subordinación de saberes, las incomprensiones, las asimetrías y los afectos involucrados en las relaciones terapéuticas vinculadas a la atención del VIH/Sida, conforme son vividas por un conjunto de pacientes y sus médicos. Este análisis forma parte de una etnografía hospitalaria realizada en un hospital público de la ciudad de Salvador de Bahía en Brasil entre los años 2004 y 2006.Neste trabalho descrevem-se e analisam situações de interação produzidas no decurso das consultas clínicas e infetológicas na atenção das pessoas que vivem com HIV/Aids. São interações que produzem processos interpretativos que operam na construção da doença assim como nas experiências relativas ao cuidado dos doentes. O análise dos olhares, gestos, as pausas e as palavras, permitem-nos compreender parte das relações de poder, a subordinação de saberes, as incompreensões, as assimetrias assim como os afetos envolvidos nas relações terapêuticas vinculadas à atenção do HIV/Aids, em tanto são vividas por um conjunto de pacientes e os seus médicos. Este análise forma parte de uma etnografia hospitalaria feita num hospital público da cidade de Salvador de Bahia, Brasil, entre os anos 2004 e 2006.This paper describes and analyzes interactions ocurring in the course of clinical-infective consultations in the care of people with HIV/AIDS. The interactions lead to interpretative processes operating in the construction of the disease and the care experiences of patients. The

  9. Organising medication discontinuation

    DEFF Research Database (Denmark)

    Nixon, Michael; Kousgaard, Marius Brostrøm

    2016-01-01

    Background: Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue...... a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP’s practice and how do GPs make decisions about discontinuing...... medication? Methods: Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. Results: The results show that different discontinuation cues (related to the type...

  10. Managing spine surgery referrals: The consultation of neurosurgery and its nuances.

    Science.gov (United States)

    Debono, B; Sabatier, P; Koudsie, A; Buffenoir, K; Hamel, O

    2017-09-04

    Spinal disorders, particularly low back pain, are among the most common reasons for general practitioner (GP) consultation and can sometimes be a source of professional friction. Despite their frequency and published guidelines, many patients are still mistakenly referred by their GP to specialists for spinal surgery consultation which can create colleague relationship problems, suboptimal or unnessary delayed care, as well as the financial implications for patients. To assess the management of GP lumbar spine referrals made to 4 neurosurgeons from 3 neurosurgical teams specialized in spinal surgery. All patient's medical records relating to 672 primary consultants over a period of two months (January and February 2015) at three institutions were retrospectively reviewed. Medical referral letters, clinical evidence and imaging data were analyzed and the patients were classified according the accuracy of surgical assessment. The final decisions of the surgeons were also considered. Of the 672 patients analyzed, 198 (29.5%) were considered unsuitable for surgical assessment: no spinal pathology=10.6%, no surgical conditions=35.4%, suboptimal medical treatment=31.3%, suboptimal radiology=18.2% and asymptomatic patients=4.5%. Unnecessary referrals to our consultation centers highlight the gap between the reason for the consultation and the indications for spinal surgery. Compliance with the guidelines, the creation of effective multidisciplinary teams, as well as the "hands on" involvement of surgeons in primary and continuing education of physicians are the best basis for a reduction in inappropriate referrals and effective patient care management. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

    NARCIS (Netherlands)

    Bensing, J.M.; Verheul, W.; Dulmen, A.M. van

    2008-01-01

    Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an

  12. Patient anxiety in the medical encounter: a study of verbal and nonverbal communication in general practice.

    NARCIS (Netherlands)

    Bensing, J.M.; Verheul, W.; Dulmen, A.M. van

    2008-01-01

    Purpose: Many patients feel anxious when entering the consultation room, but seldom verbalize their emotions explicitly in the medical encounter. The authors designed a study to analyse the visibility of patient pre-consultation (state) anxiety in their communication during the consultation. In an a

  13. Can audio recording improve patients' recall of outpatient consultations?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    Introduction In order to give patients possibility to listen to their consultation again, we have designed a system which gives the patients access to digital audio recordings of their consultations. An Interactive Voice Response platform enables the audio recording and gives the patients access...... to replay their consultation. The intervention is evaluated in a randomised controlled trial with 5.460 patients in order to determine whether providing patients with digital audio recording of the consultation affects the patients overall perception of their consultation. In addition to this primary...... objective we want to investigate if replay of the consultations improves the patients’ recall of the information given. Methods Interviews are carried out with 40 patients whose consultations have been audio recorded. Patients are divided into two groups, those who have listened to their consultation...

  14. Consultants and organization concepts; tracing routes of reception

    NARCIS (Netherlands)

    Heusinkveld, Stefan; Benders, Jos

    2001-01-01

    The aim of this paper is to explore how organization concepts evolve within consulting organizations. These companies are characterized by specific historical backgrounds, organization forms, particular services and include consultants with their own professional interests and competencies. As a con

  15. 75 FR 72838 - Notice of Tribal Consultations; Schedule Update

    Science.gov (United States)

    2010-11-26

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Indian Gaming Commission Notice of Tribal Consultations; Schedule Update AGENCY: National Indian Gaming Commission, Department of Interior. ACTION: Notice of tribal consultations; schedule...

  16. Exploring employment in consultation reports of patients with neuromuscular diseases

    NARCIS (Netherlands)

    Heerkens, Yvonne; Kuyk-Minis, Marie Antoinette van; Cup, Edith; Engels, Josephine; Engelen, Baziel van; Oostendorp, Rob

    2012-01-01

    To explore consultation reports for patient and employment characteristics and recommendations on employment regarding patients with neuromuscular diseases (NMDs). Eighty percent of the included consultation reports contained information on employment. Less than half the patients with NMD were emplo

  17. The Role of Design Consultants in Innovation Strategy Decisionmaking

    NARCIS (Netherlands)

    Calabretta, G.; Gemser, G.; Wijnberg, N.M.; Hekkert, P.P.M.

    2013-01-01

    To contain risks and increase the profitability of innovation efforts, firms frequently engage in joint innovation activities with external sources of knowledge, like design consultancies. Innovation literature has given limited consideration to the strategic role that design consultancies can play

  18. Exploring employment in consultation reports of patients with neuromuscular diseases

    NARCIS (Netherlands)

    Minis, M.A.H; Cup, E.H.C.; Heerkens, Y.F.; Engels, J.A.; Engelen, B.G. van; Oostendorp, R.A.B.

    2012-01-01

    Minis MA, Cup EH, Heerkens YF, Engels JA, van Engelen BG, Oostendorp RA. Exploring employment in consultation reports of patients with neuromuscular diseases. OBJECTIVES: To explore consultation reports for patient and employment characteristics and recommendations on employment regarding patients

  19. The Application of Cognitive Dissonance Theory to Consultation.

    Science.gov (United States)

    Hughes, Jan N.

    1983-01-01

    Summarizes aspects of cognitive dissonance theory (theory that predicts when a particular persuasive attempt will be successful) that are most relevant to consultation. Reviews the corresponding experimental support and suggests practical applications of dissonance research and theory to consultation. (LLL)

  20. Trend of newspaper consultation by students of federal University of ...

    African Journals Online (AJOL)

    Trend of newspaper consultation by students of federal University of Technology, Owerri. ... Data was obtained from the University Library's Records of users' statistics for Newspaper consultation for ten years, 2004-2013. ... Article Metrics.

  1. Business Communication Consulting and Research in Multinational Companies.

    Science.gov (United States)

    Hildebrandt, Herbert W.

    1978-01-01

    Describes three issues involved in communication research and consulting for multinational companies, particularly those in Germany: qualifications for doing international consulting and research, problems of American scholar-researchers in those firms, and suggestions for dealing with those issues. (JMF)

  2. 'Grounded' Politics

    DEFF Research Database (Denmark)

    Schmidt, Garbi

    2012-01-01

    play within one particular neighbourhood: Nørrebro in the Danish capital, Copenhagen. The article introduces the concept of grounded politics to analyse how groups of Muslim immigrants in Nørrebro use the space, relationships and history of the neighbourhood for identity political statements....... The article further describes how national political debates over the Muslim presence in Denmark affect identity political manifestations within Nørrebro. By using Duncan Bell’s concept of mythscape (Bell, 2003), the article shows how some political actors idealize Nørrebro’s past to contest the present...

  3. Consultant supported ERP implementation – a learning opportunity?

    OpenAIRE

    2005-01-01

    Management consultants are often described as accumulators, generators and disseminators of knowledge in the business world. Little research has however been devoted to the extent to which and the processes by which organizations hiring management consultants learn. This issue is addressed in the current paper based on a study of a consultant-supported ERP (Enterprise Resource Planning) implementation project. It is concluded, that projects in which consultants and employees of the hiring org...

  4. Innovation in consulting firms: what are the foundations?

    OpenAIRE

    Lemus Aguilar, Isaac; Hidalgo Nuchera, Antonio

    2015-01-01

    Innovation inside consulting firms has missed specific attention in academic research. Consulting firms usually are considered to be part of Knowledge-Intensive Business Services (KIBS), Professional Service Firms (PSF) or Project-based Firms (PbF). However, consultancies possess particular characteristics that might affect generalizations made in studies targeting all the categories stated before. Consulting firms usually help other companies to be innovative, but they also need to have inno...

  5. What to listen for in the consultation

    DEFF Research Database (Denmark)

    Jensen, Christian Gaden; Elsass, Peter; Neustrup, Line

    2014-01-01

    scale (CES-D). RESULTS: Among the qualitative themes, only the percentage of words spent on talking about 'Acceptance-based psychological coping' was related to symptoms. In regression models controlling for age, education and time since diagnosis, a stronger focus on acceptance-based coping predicted......OBJECTIVE: To analyze whether qualitative themes in breast cancer patients' self-presentations predicted symptoms of psychological distress and depression in order to improve the consultation process. METHODS: Ninety-seven breast cancer patients gave unstructured, 10-min self......-presentations at their first consultation in a clinical registered trial (CRT identifier: NCT00990977). Self-presentations were categorized thematically and the most prevalent themes investigated as predictors for scores on the symptom check-list 90-revised (SCL-90-R) and the center for epidemiological studies depression...

  6. [Civil, criminal and ethical liability of medical doctors].

    Science.gov (United States)

    Udelsmann, Artur

    2002-01-01

    In the last years doctors have been the target of a growing number of civil, criminal law suits, as well as ethical procedures. Medicine is a widely targeted career, not only owing to its inherent risks, but also owing to a mistaken approach of the Judiciary Power about the obligations of medical doctors. Decisions of the Medical Board in ethical procedures have an impact in civil and criminal justice and therefore should be followed closely. The purpose of this review is to provide a wide view from a doctor-lawyer perspective of cases involving civil, criminal liability of anesthesiologists as well as ethical procedures against them, in an effort to make them comprehensible to doctors. After a brief historical introduction civil liability foundations and legal articles are examined. Responsibilities of doctors, hospitals and health insurance providers are discussed separately, as well as reparation mechanisms. Crimes possible to occur during medical practice and respective penalties are described; the direct relationship between crime and civil reparation is demonstrated. The administrative nature of ethical procedure is described, emphasizing that the legal character of its penalties often serve as grounds for civil and criminal justice decisions. Prevention is still the best medicine. Good medical practice and a good medical-patient relationship are still the best ways to minimize lawsuits and their repercussions. Doctors should have some knowledge of juridical mechanisms in lawsuits and ethical procedures, but should not take defense initiatives without prior consultation of an attorney. Civil, criminal and ethical liability of physicians.

  7. Consulting as a Strategy for Knowledge Transfer

    OpenAIRE

    Jacobson, Nora; Butterill, Dale; Goering, Paula

    2005-01-01

    Academic researchers who work on health policy and health services are expected to transfer knowledge to decision makers. Decision makers often do not, however, regard academics’ traditional ways of doing research and disseminating their findings as relevant or useful. This article argues that consulting can be a strategy for transferring knowledge between researchers and decision makers and is effective at promoting the “enlightenment” and “interactive” models of knowledge use. Based on thre...

  8. ACCOUNTING A CONSULTANT IN THE MANAGEMENT PROCESS

    Directory of Open Access Journals (Sweden)

    VIRAG NICOLAE PAUL

    2012-05-01

    Full Text Available Management process is a continuous activity that requires the achievement of the essential objectives of the entity. This involves knowing and understanding how should be implemented major functions of management to ensure the desired performance. Accounting, as part of the management process, specifically contribute to the value of the entity. In this paper we want to present how accounting acts as a consultant to managers, helping them in decision making process.

  9. Users enlist consultants to calculate costs, savings

    Energy Technology Data Exchange (ETDEWEB)

    1982-05-24

    Consultants who calculate payback provide expertise and a second opinion to back up energy managers' proposals. They can lower the costs of an energy-management investment by making complex comparisons of systems and recommending the best system for a specific application. Examples of payback calculations include simple payback for a school system, a university, and a Disneyland hotel, as well as internal rate of return for a corporate office building and a chain of clothing stores. (DCK)

  10. Republic of Kazakhstan; 2013 Article IV Consultation

    OpenAIRE

    International Monetary Fund

    2013-01-01

    This paper analyzes the Republic of Kazakhstan’s 2013 Article of Consultation. The IMF report focuses on vision of developing Kazakhstan into a leading emerging market economy requires concerted efforts to strengthen the policy architecture. It highlights the importance of enhancing the diversification strategy by strengthening institutions, the business environment, and human capital, while carefully managing the country’s oil wealth. It also discusses that the unification of the pension...

  11. Internship at Taylor Fry Consulting Actuaries

    OpenAIRE

    Kierkels, Bram Joseph Johannes

    2013-01-01

    Mestrado em Ciências Actuariais As the final part of the master degree, I started my internship on 25 Febru- ary 2013 at Taylor Fry Consulting Actuaries. During the internship my work mainly involved analyzing the outstanding workers compensation liabilities for self-insured clients. In this report I will describe the process of this anal- ysis. Throughout this report I will explain the procedures I used to value outstanding claims.

  12. Bridging Theory and Practice: A Conceptual Framework for Consulting Organisations

    Science.gov (United States)

    Mohammed, Meca B.; Welch, Jennie; Hazle Bussey, Leslie

    2015-01-01

    A growing number of organisations are emerging as partners to districts pursuing systemic improvement. Given the critical role a consulting organisation could play in supporting system reform efforts, how does a district leader looking to establish a consulting partnership determine what characteristics in a consulting organisation may be more…

  13. Crisis Communication Consultation of the Federal Reserve Bank System

    Science.gov (United States)

    Chandler, Robert C.; Wallace, J. D.

    2008-01-01

    This article, designed for both consulting practitioners and academics, reveals what it is like to do a high-level and high-profile client consultancy. This consultancy was highly informed by and assumes a working knowledge of instructional communication theory, research, and methods as well as drawing upon contemporary communication scholarship…

  14. Bridging Theory and Practice: A Conceptual Framework for Consulting Organisations

    Science.gov (United States)

    Mohammed, Meca B.; Welch, Jennie; Hazle Bussey, Leslie

    2015-01-01

    A growing number of organisations are emerging as partners to districts pursuing systemic improvement. Given the critical role a consulting organisation could play in supporting system reform efforts, how does a district leader looking to establish a consulting partnership determine what characteristics in a consulting organisation may be more…

  15. Teaching Evaluation: A Student-Run Consulting Firm

    Science.gov (United States)

    Cundiff, Nicole; Nadler, Joel; Scribner, Shauna

    2011-01-01

    Applied Research Consultants (ARC) is a graduate student run consulting firm that provides experience to students in evaluation and consultation. An overview of this program has been compiled in order to serve as a model of a graduate training practicum that could be applied to similar programs or aid in the development of such programs. Key…

  16. 5 CFR 2426.13 - Obligation to consult.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Obligation to consult. 2426.13 Section 2426.13 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL OF THE FEDERAL... Regulations § 2426.13 Obligation to consult. (a) When a labor organization has been accorded consultation...

  17. 5 CFR 2426.3 - Obligation to consult.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Obligation to consult. 2426.3 Section 2426.3 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL OF THE FEDERAL LABOR... GOVERNMENT-WIDE RULES OR REGULATIONS National Consultation Rights § 2426.3 Obligation to consult. (a) When a...

  18. 29 CFR 779.515 - Regulations should be consulted.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Regulations should be consulted. 779.515 Section 779.515... Records to Be Kept by Employers § 779.515 Regulations should be consulted. This discussion in subpart F of... employer subject to any provision of the Act should consult the regulations to determine what records he...

  19. 15 CFR 200.103 - Consulting and advisory services.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Consulting and advisory services. 200..., SERVICES, PROCEDURES, AND FEES § 200.103 Consulting and advisory services. (a) In areas of its special competence, NIST offers consulting and advisory services on various problems related to measurement, e.g...

  20. 45 CFR 400.57 - Planning and consultation process.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Planning and consultation process. 400.57 Section... Refugee Cash Assistance § 400.57 Planning and consultation process. A State that wishes to establish a public/private RCA program must engage in a planning and consultation process with the local agencies...

  1. Multicultural Counseling Competence Training: Adding Value with Multicultural Consultation

    Science.gov (United States)

    Jones, Janine M.; Kawena Begay, Kristin; Nakagawa, Yoko; Cevasco, Molly; Sit, Janelle

    2016-01-01

    This study addresses the culturally responsive training process and highlights the integration of multicultural competence building in counseling consultation. Consultation was structured as client-centered case consultation. Before and after the intervention, clinician competence was assessed with the California Brief Multicultural Counseling…

  2. Multicultural Counseling Competence Training: Adding Value with Multicultural Consultation

    Science.gov (United States)

    Jones, Janine M.; Kawena Begay, Kristin; Nakagawa, Yoko; Cevasco, Molly; Sit, Janelle

    2016-01-01

    This study addresses the culturally responsive training process and highlights the integration of multicultural competence building in counseling consultation. Consultation was structured as client-centered case consultation. Before and after the intervention, clinician competence was assessed with the California Brief Multicultural Counseling…

  3. A Rational-Emotive Therapy Approach to Consultation

    Science.gov (United States)

    Forman, Susan G.; Forman, Bruce D.

    1978-01-01

    The application of Rational-Emotive Therapy in the practice of consultee-centered consultation is discussed. The consultant's task is to identify those irrational beliefs which are impeding consultee job-effectiveness and to help modify these beliefs. Several common consultation problems and techniques for their management are presented. (Author)

  4. Consultancy and innovation the business service revolution in Europe

    CERN Document Server

    Wood, Peter

    2003-01-01

    Consultancy and Innovation links two important aspects of European economic development in the past thirty years: the pace of technical and management innovation, and the growing significance of technical and business consultancy. This book includes detailed studies of consultancy activities or 'knowledge intensive services' (KIS) in eight EU countries, written by national experts in the field.

  5. The Development of Behaviorally Based Public School Consultation Services

    Science.gov (United States)

    Putnam, Robert F.; Handler, Marcie W.; Rey, Jannette; McCarty, Joseph

    2005-01-01

    This article describes the development of behavioral school care consultation services to public schools within a not-for-profit community behavioral health organization. An overview of the process of behavior consultation is presented. A description of the growth of behavioral school consultation services is outlined in regard to (a) the types of…

  6. Psychiatric outpatient consultation for seniors. Perspectives of family physicians, consultants, and patients / family: A descriptive study

    Directory of Open Access Journals (Sweden)

    Dendukuri Nandini

    2005-04-01

    Full Text Available Abstract Background Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. Methods An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. Results 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. Conclusion Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.

  7. Moving It Along: A study of healthcare professionals' experience with ethics consultations.

    Science.gov (United States)

    Crigger, Nancy; Fox, Maria; Rosell, Tarris; Rojjanasrirat, Wilaiporn

    2017-05-01

    Ethics consultation is the traditional way of resolving challenging ethical questions raised about patient care in the United States. Little research has been published on the resolution process used during ethics consultations and on how this experience affects healthcare professionals who participate in them. The purpose of this qualitative research was to uncover the basic process that occurs in consultation services through study of the perceptions of healthcare professionals. The researchers in this study used a constructivist grounded theory approach that represents how one group of professionals experienced ethics consultations in their hospital in the United States. The results were sufficient to develop an initial theory that has been named after the core concept: Moving It Along. Three process stages emerged from data interpretation: moral questioning, seeing the big picture, and coming together. It is hoped that this initial work stimulates additional research in describing and understanding the complex social process that occurs for healthcare professionals as they address the difficult moral issues that arise in clinical practice.

  8. Medical undergraduate primary care teaching across the UK: what is being taught?

    Science.gov (United States)

    Boon, Veronica; Ridd, Matthew; Blythe, Andrew

    2017-01-01

    All UK medical schools use primary care settings to deliver their undergraduate courses. However there is no national undergraduate curriculum for primary care and it is thought that the learning objectives of primary care teaching vary considerably between medical schools. The overall aim was to establish what is being taught within and by primary care across UK medical schools. We did this by collating learning objectives from the primary care department at each school. In order to categorise and compare the list of learning objectives from each school we mapped the learning objectives to the postgraduate curriculum of the Royal College of General Practitioners (RCGP). Cross sectional survey sent to heads of teaching of primary care at all 32 UK medical schools. GP teacher handbooks for primary care modules at each medical school were requested. Information was extracted based on key headings from the RCGP postgraduate curriculum. Topics taught by primary care at all medical schools include: consulting and communication skills, leading and working in teams, and developing yourself and others. Novel topics, taught at a few medical schools include: learning disability, genetics and multi-morbidity. The majority of medical schools address aspects of over half of the RCGP postgraduate curriculum headings in their learning objectives for primary care. This project provides valuable information about primary care teaching at an undergraduate level across the UK. Although it confirms widespread variation in learning objectives, it also highlights considerable common ground and opportunities for sharing teaching resources between schools.

  9. Statistics teaching in medical school: opinions of practising doctors.

    Science.gov (United States)

    Miles, Susan; Price, Gill M; Swift, Louise; Shepstone, Lee; Leinster, Sam J

    2010-11-04

    The General Medical Council expects UK medical graduates to gain some statistical knowledge during their undergraduate education; but provides no specific guidance as to amount, content or teaching method. Published work on statistics teaching for medical undergraduates has been dominated by medical statisticians, with little input from the doctors who will actually be using this knowledge and these skills after graduation. Furthermore, doctor's statistical training needs may have changed due to advances in information technology and the increasing importance of evidence-based medicine. Thus there exists a need to investigate the views of practising medical doctors as to the statistical training required for undergraduate medical students, based on their own use of these skills in daily practice. A questionnaire was designed to investigate doctors' views about undergraduate training in statistics and the need for these skills in daily practice, with a view to informing future teaching. The questionnaire was emailed to all clinicians with a link to the University of East Anglia Medical School. Open ended questions were included to elicit doctors' opinions about both their own undergraduate training in statistics and recommendations for the training of current medical students. Content analysis was performed by two of the authors to systematically categorize and describe all the responses provided by participants. 130 doctors responded, including both hospital consultants and general practitioners. The findings indicated that most had not recognised the value of their undergraduate teaching in statistics and probability at the time, but had subsequently found the skills relevant to their career. Suggestions for improving undergraduate teaching in these areas included referring to actual research and ensuring relevance to, and integration with, clinical practice. Grounding the teaching of statistics in the context of real research studies and including examples of

  10. Statistics teaching in medical school: Opinions of practising doctors

    Directory of Open Access Journals (Sweden)

    Shepstone Lee

    2010-11-01

    Full Text Available Abstract Background The General Medical Council expects UK medical graduates to gain some statistical knowledge during their undergraduate education; but provides no specific guidance as to amount, content or teaching method. Published work on statistics teaching for medical undergraduates has been dominated by medical statisticians, with little input from the doctors who will actually be using this knowledge and these skills after graduation. Furthermore, doctor's statistical training needs may have changed due to advances in information technology and the increasing importance of evidence-based medicine. Thus there exists a need to investigate the views of practising medical doctors as to the statistical training required for undergraduate medical students, based on their own use of these skills in daily practice. Methods A questionnaire was designed to investigate doctors' views about undergraduate training in statistics and the need for these skills in daily practice, with a view to informing future teaching. The questionnaire was emailed to all clinicians with a link to the University of East Anglia Medical School. Open ended questions were included to elicit doctors' opinions about both their own undergraduate training in statistics and recommendations for the training of current medical students. Content analysis was performed by two of the authors to systematically categorise and describe all the responses provided by participants. Results 130 doctors responded, including both hospital consultants and general practitioners. The findings indicated that most had not recognised the value of their undergraduate teaching in statistics and probability at the time, but had subsequently found the skills relevant to their career. Suggestions for improving undergraduate teaching in these areas included referring to actual research and ensuring relevance to, and integration with, clinical practice. Conclusions Grounding the teaching of statistics

  11. Variation in end-of-life decision making between critical care consultants.

    Science.gov (United States)

    Poulton, B; Ridley, S; Mackenzie-Ross, R; Rizvi, S

    2005-11-01

    Considerable variation in end-of-life decision making is reported between intensive care units in the United Kingdom, possibly because of differences in casemix. Senior medical staff within any one unit should, however, be consistent in such decision making. We reviewed the medical records for a 4-year period to establish if there was consistency in our own unit. This revealed considerable variation in the apparent willingness of consultants to make end-of-life decisions, emphasising the subjective nature of these decisions. Personality typing (Myers-Briggs Type Indicator) of consultants revealed that those who had made more than the expected number of decisions had scores towards the judging end of the judging/perceiving domain.

  12. Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

    Directory of Open Access Journals (Sweden)

    Patrick Hoek

    Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

  13. Child Care Reform Consultation Infopack = Consultation sur la reforme des services de garde d'enfants. Trousse d'information.

    Science.gov (United States)

    Ontario Ministry of Community and Social Services, Toronto.

    This information packet presented here in both the English and French language versions, summarizes the results of a public consultation on the subject of child care reform in Ontario, Canada. The packet consists of: (1) a table that describes the six modes of consultation that were used in the consultation process (public meetings, round table…

  14. Consultation needs in perinatal HIV care: experience of the National Perinatal HIV Consultation Service.

    Science.gov (United States)

    Fogler, Jessica A; Weber, Shannon; Goldschmidt, Ronald H; Mahoney, Megan R; Cohan, Deborah

    2007-09-01

    This study evaluates the consultation needs of clinicians who provide perinatal human immunodeficiency virus (HIV) care in the United States. The Perinatal Hotline (1-888-448-8765) is a telephone consultation service for providers who treat HIV-infected pregnant women and their infants. Hotline calls were analyzed for demographics about callers and their patients and information about consultation topics. There were 430 calls to the hotline from January 1, 2005, through June 30, 2006. Most calls (59.5%) were related to pregnant patients; 5.1% of the calls pertained to women currently in labor. The most common topic was HIV care in pregnancy (49.1%), particularly antiretroviral drug use (42.1%). HIV testing was discussed in 21.9%, and intrapartum treatment was discussed in 24.0%. Callers most often requested help choosing antiretroviral drug regimens; many of the discussions were about drug toxicities and viral resistance. Although the hotline received few calls about women in labor, the need for these consultations is expected to increase with the expanding use of rapid HIV testing. Access to 24-hour consultation can help ensure that state-of-the-art care is provided.

  15. Telemedicine-based physician consultation results in more patients treated and released by ambulance personnel

    DEFF Research Database (Denmark)

    Raaber, Nikolaj; Bøtker, Morten T; Riddervold, Ingunn S

    2016-01-01

    . In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation...... a physician at the EMCC and ambulance personnel and noncritically ill 1-1-2 patients results in an increased rate of patients treated and released with high satisfaction. The approach does not seem to compromise patient safety....

  16. Prescribing for personality disorder: qualitative study of interviews with general and forensic consultant psychiatrists

    OpenAIRE

    Martean, Lawrence; Evans, Chris

    2014-01-01

    Aims and method To explore experiences of psychiatrists considering medication for patients with personality disorder by analysis of transcribed, semi-structured interviews with consultants. Results Themes show important relational processes in which not prescribing is expected to be experienced as uncaring rejection, and psychiatrists felt helpless and inadequate as doctors when unable to relieve symptoms by prescribing. Discontinuity in doctor-patient relationships compounds these problems....

  17. Clinical and demographic profile of cancer patients in a consultation-liaison psychiatric service

    Directory of Open Access Journals (Sweden)

    Vanessa de Albuquerque Citero

    Full Text Available ABSTRACT CONTEXT: An almost 50% prevalence of psychiatric disorders among cancer patients has prompted a series of studies on consultation-liaison psychiatry. Nonetheless, there are few reports on the epidemiological factors involving comorbidity between cancer and psychiatric disorders. OBJECTIVE: To evaluate the epidemiological profile of cancer inpatients referred to the consultation-liaison psychiatric service in an oncology hospital during its first year of activity. TYPE OF STUDY: Descriptive study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: 319 patients referred 412 times to the consultation-liaison psychiatry service. PROCEDURES: From August 97 to July 98, an appraisal was made of data on all admissions registered at the Hospital do Câncer, and also all referrals registered at the consultation-liaison psychiatry service. MAIN MEASUREMENTS: The demographics and patients' clinical data, the type and flow of the request, and the evaluation conducted by the service were analyzed and comparisons with the hospital data were made. The distribution of the number of referrals was used to construct a profile of patients who had repeatedly used the service. RESULTS: Psychiatric diagnoses were found in 59% of the cases. Forty-three percent of these required medication, 18.3% needed psychotherapy, 22.1% family intervention and 20.5% guidance from the staff. Over 22.8% of the consultations were reevaluations, mainly involving younger male patients with worst prognoses. These patients required lengthier and more elaborate intervention, and had higher prevalence of depressive and behavioral disorders. CONCLUSION: A younger and mainly male population of non-surgical oncological cases was referred to the consultation-liaison psychiatric service during its first year of activity. The psychiatric disorder prevalence was higher than expected, and consisted predominantly of mood disorders. We detected a priority group, namely the reevaluated

  18. Preliminary Data from an Advanced Dementia Consult Service: Integrating Research, Education, and Clinical Expertise

    Science.gov (United States)

    Catic, Angela G.; Mitchell, Susan L.

    2013-01-01

    Hospitalized patients with advanced dementia often receive care that is of limited clinical benefit and inconsistent with preferences. We designed an Advanced Dementia Consult Service and conducted a pre and post pilot study to evaluate it in a Boston hospital. Consults were conducted by geriatricians and palliative care nurse practitioner. They consisted of structured consultation, counseling and provision of an information booklet to the family, and post-discharge follow-up with the family and primary care providers. Patients > 65 admitted with advanced dementia were identified and consults were solicited using pop-ups programmed into the computerized provider order entry (POE) system. In the initial 3-month period, patients received usual care (N=24). In the subsequent 3-month period, consults were provided to patients for whom it was requested (N=5). Data were obtained from the electronic medical record and proxies interviews (admission, 1-month post-discharge). The patients’ mean age in the combined sample (N=29) was 85.4, 58.6% were from nursing homes, and 86.2% of their proxies stated comfort was the goal of care. Nonetheless, their hospitalizations were characterized by high rates of intravenous antibiotics (86.2%), > 5 venipunctures (44.8%), and radiological exams (96.6%). Acknowledging the small sample size, there were trends towards better outcomes in the intervention group including: higher proxy knowledge of the disease, greater communication between proxies and providers, more advance care planning, lower re-hospitalization rates, and fewer feeding tube insertions after discharge. Targeted consultation for advanced dementia is feasible and may promote greater engagement of proxies and goal-directed care for patients after discharge. PMID:24219202

  19. Toxicological consultation data management system based on experience of Pomeranian Center of Toxicology

    Directory of Open Access Journals (Sweden)

    Piotr Maciej Kabata

    2015-10-01

    Full Text Available Background: In this paper the structure of poisonings is described, based on the material collected from tele-toxicology consults by the Pomeranian Center of Toxicology in Gdańsk and harvested from its Electronic Poison Information Management System. In addition, we analyzed conclusions drawn from a 27-month operation of the system. Material and Methods: Data were harvested from the Electronic Poison Information Management System developed in 2012 and used by the Pomeranian Center of Toxicology since then. The research was based on 2550 tele-toxicology consults between January 1 and December 31, 2014. Subsequently the data were electronically cleaned and presented using R programming language. Results: The Pomeranian voivodeship was the prevalent localisation of calls (N = 1879; 73.7%. Most of the calls came from emergency rooms (N = 1495; 58.63%. In the case of 1396 (54.7% patients the time-lag between intoxication and the consult was less than 6 h. There were no differences in the age distribution between genders. Mean age was 26.3 years. Young people predominated among intoxicated individuals. The majority of intoxications were incidental (N = 888; 34.8% or suicidal (N = 814; 31.9% and the most of them took place in the patient’s home. Conclusions: Information about Poison Control Center consultations access should be better spread among medical service providers. The extent of poison information collected by Polish Poison Control Centers should be limited and unified. This should contribute to the increased percentage of properly documented consultations. Additional duties stemming from the need of digital archiving of consults provided, require the involvement of additional staff, leading to the increased operation costs incurred by Poison Control Centers. Med Pr 2015;66(5:635–644

  20. An imminent human resource crisis in ground water hydrology?

    Science.gov (United States)

    Stephens, Daniel B

    2009-01-01

    Anecdotal evidence, mostly from the United States, suggests that it has become increasingly difficult to find well-trained, entry-level ground water hydrologists to fill open positions in consulting firms and regulatory agencies. The future prospects for filling positions that require training in ground water hydrology are assessed by considering three factors: the market, the numbers of qualified students entering colleges and universities, and the aging of the existing workforce. The environmental and water resources consulting industry has seen continuous albeit variable growth, and demand for environmental scientists and hydrologists is expected to increase significantly. Conversely, students' interest and their enrollment in hydrology and water resources programs have waned in recent years, and the interests of students within these departments have shifted away from ground water hydrology in some schools. This decrease in the numbers of U.S. students graduating in hydrology or emphasizing ground water hydrology is coinciding with the aging of and pending retirement of ground water scientists and engineers in the baby boomer generation. We need to both trigger the imagination of students at the elementary school level so that they later want to apply science and math and communicate the career opportunities in ground water hydrology to those high school and college graduates who have acquired the appropriate technical background. Because the success of a consulting firm, research organization, or regulatory agency is derived from the skills and judgment of the employees, human resources will be an increasingly more critical strategic issue for many years.

  1. SOME INDICATORS OF CONSULTATIVE SERVICES DEVELOPMENT IN SERBIA

    Directory of Open Access Journals (Sweden)

    Vesna PARAUSIC

    2012-01-01

    Full Text Available Transition process and Serbia's entering into the European Union is possible to hasten by adequate and timely consultative services, before all during the programs and methodologies creation for conducting the enterprises' restructuring processes. In such conditions, the consultative organizations help the enterprises in accomplishing their goals, solving problems in business and management, identifying and using new possibilities, increasing their knowledge and applying suggested changes in the practice. Consulting is a result of manager need for integrated and complex business information. To obtain the transfer of consultant knowledge and manager skills development, a certain conditions must be fulfilled. First of all, business integrity and consultant competence are the most important. Business integrity, i.e. consultant ethics contributes image and reputation and is important competitiveness factor on consultant services market. Regarding actual consulting trends in countries within our region, as well as developmental level of consulting in EU countries, the market of consultative services in Serbia has not significantly changed in previous period (as we saw, the acknowledgement of it was got also by empirical research. The owners and managers of enterprises still do not feel a need for external services, in order to solve business problems. Having in mind a level and quality of demand, neither a supply of consultative services had not reached satisfactory level.

  2. SOME REFLECTIONS UPON MANAGEMENT CONSULTING AS PROFESSIONAL SERVICES

    Directory of Open Access Journals (Sweden)

    Botezat Elena

    2008-05-01

    Full Text Available Management consulting helping organizations improve their performance, primarily through the thorough analysis of existing business problems and development of plans for improvement. There is probably no activity about which the opinions are so divided as management consulting. The purpose of this paper is to make some reflections upon what role play the consulting management services as professional service to the firms and how offering these services affects the offering and delivery of other services of the firms. The study is based on an office documentation research within consulting firms and resources. The approach tries to be critical and reflective, examines different consulting roles by developing a typology. The purpose is to aware of these professional services young business people. The FAQ of this service are: “How to choose the best consultant?” and “Why did fail consultant?”.

  3. Young people's views on the potential use of telemedicine consultations for sexual health: results of a national survey

    Directory of Open Access Journals (Sweden)

    Fairley Christopher K

    2011-10-01

    sexual health services. Although only 29% of respondents were willing to have a webcam consultation, such a service may benefit youth who may not otherwise access a sexual health service. The acceptability of webcam consultations may be increased if medical clinics provide clear and accessible privacy policies ensuring that consultations will not be recorded or saved.

  4. Adapting services to the needs of children and families with complex migration experiences: The Toulouse University Hospital's intercultural consultation.

    Science.gov (United States)

    Sturm, Gesine; Guerraoui, Zohra; Bonnet, Sylvie; Gouzvinski, Françoise; Raynaud, Jean-Philippe

    2017-08-01

    This article presents the recently created intercultural consultation at the Medical and Psychological Health Care Service (CMP) of the University Hospital la Grave at Toulouse. The approach of the intercultural consultation was elaborated in response to the increasing diversity of children and families using the service in Toulouse. It is also based on local research that indicates the difficulties service providers encounter when trying to establish a solid therapeutic alliance with families with complex migration backgrounds who accumulate different disadvantaging factors. The intercultural consultation adapts existing models of culture-sensitive consultations in child mental health care in France and Canada to the local context in Toulouse. We describe the underlying principles of the intercultural consultation work, the therapeutic and mediation techniques used, and the way the work is integrated into the global service provision of the CMP. The process is illustrated with a case study followed by a discussion of the innovations.

  5. Presentation of self and symptoms in primary care consultations involving patients from non-English speaking backgrounds.

    Science.gov (United States)

    Roberts, Celia; Sarangi, Srikant; Moss, Becky

    2004-01-01

    This paper draws on the PLEDGE research project (Patients with Limited English and Doctors in General Practice) 1 The Patients with Limited English and Doctors in General Practice (PLEDGE) project was funded by Sir Siegmund Warburg's Voluntary Settlement (2001-2003). The research team was: Celia Roberts, Roger Jones, Becky Moss, Srikant Sarangi and Val Wass. which has a database of 232 video-recorded interactions from GP surgeries in South East London. We focus on the opening episodes-the first opportunity the patient has to report on why they have come to see the doctor-to explore some of the contrasts in self presentation and the interactional work that doctors do when faced with the unexpected. Patients who speak a local London or standard variety of English present three aspects: a description of symptoms, the context in which they occurred, and an affective or epistemic stance. These 'micro discourse routines' are accomplished interactionally through the design of figure/ground relationships, framing and metacommunication and presentation of the 'moral self'. Although some patients from non-English speaking backgrounds use broadly similar 'micro discourse routines', the majority configure the relationship between medically salient facts, adequate contextual information and the stance which conveys the 'moral self' in different and apparently less 'orderly' ways. So openings often become protracted and harder work interactionally for both sides. While conversation analytic studies and communication skills textbooks represent the medical consultations as orderly, we suggest that such apparent orderliness must, at least, be partly the result of ironing out linguistic and cultural diversity. Interactional sociolinguistic analysis is used to shed light on the design of these routines and to provide analytic frameworks for doctors in reflecting on their own practice in ways which challenge patient-centred models.

  6. Risk communication in the clinical consultation.

    Science.gov (United States)

    Thomson, Richard; Edwards, Adrian; Grey, Jenny

    2005-01-01

    Modern healthcare and modern societies are facing up to the need for greater engagement of patients in treatment decisions. Shared and informed decision-making is replacing traditional paternalistic approaches to decisions; health policy both reflects and drives these changes. A critical contribution to better informed decisions by patients is the effective communication of risk in the clinical consultation. This is not straightforward, but there is a growing evidence base to improve performance in this area to the benefit of both patients and clinicians. The purpose of this review is to provide an accessible and practical guide to better communication of risk by clinicians.

  7. The duty to consult and legal obligations

    Energy Technology Data Exchange (ETDEWEB)

    Carpenter, A.W. [Lawson Lundell Lawson and MacIntosh, Calgary, AB (Canada)

    2002-07-01

    Aboriginal law in Canada has been evolving and industry is beginning to engage in the change. This presentation describes the legal aspects regarding Aboriginal rights and the duty to consult First Nations regarding treaty rights. The implications for First Nations and industry are described. Aboriginal peoples of Canada include the Indian, Inuit and Metis populations. Aboriginal titles exist, therefore they are constitutionally protected. The paper describes recent decisions regarding the Mikisew Cree First Nation versus Canada, the Taku River Tlinget versus Ringstad, and the Haida Nation versus British Columbia and Weyerhaeuser.

  8. Client/consultant model services agreement

    CERN Document Server

    International Federation of Consulting Engineers

    2006-01-01

    The terms of the Client Consultant Model Services agreement (The White Book) have been prepared by the Fédération Internationale des Ingénieurs-Conseils (FIDIC) and are recommended for general use for the purposes of pre-investment and feasibility studies, designs and administration of construction and project management, where proposals for such services are invited on an international basis. They are equally adaptable for domestic agreements. - See more at: http://fidic.org/books/clientconsultant-model-services-agreement-4th-ed-2006-white-book#sthash.3Uxy5qT3.dpuf

  9. Shifts in doctor-patient communication during a series of outpatient consultations in non-insulin-dependent diabetes mellitus.

    NARCIS (Netherlands)

    Dulmen, A.M. van; Verhaak, P.F.M.; Bilo, H.J.G.

    1997-01-01

    As the treatment of non-insulin-dependent diabetes mellitus (NIDDM) largely depends on self-management, patient compliance and satisfaction, diabetes-specific beliefs and fears need special consideration during medical consultations by means of effective communication. Communication patterns are li

  10. Sub-optimal patient and physician communication in primary care consultations: its relation to severe and difficult asthma

    NARCIS (Netherlands)

    Moffat, M.; Cleland, J.; Van der Molen, T.; Price, D.

    2006-01-01

    Introduction: Asthma control can be influenced by a range of non-medical issues, including psychosocial factors. Little is known about the views of patients, particularly those with severe and/or difficult asthma, towards their asthma control and their asthma-related primary care consultations. Aims

  11. Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting.

    Science.gov (United States)

    DiPiro, Pamela J; Krajewski, Katherine M; Giardino, Angela A; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H

    2017-01-01

    The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

  12. Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting

    Science.gov (United States)

    Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H.

    2017-01-01

    The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners. PMID:28096715

  13. Radiology consultation in the era of precision oncology: A review of consultation models and services in the tertiary setting

    Energy Technology Data Exchange (ETDEWEB)

    DiPiro, Pamela J.; Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H. [Dept. of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States)

    2017-01-15

    The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

  14. The effect of the full moon on general practice consultation rates.

    Science.gov (United States)

    Neal, R D; Colledge, M

    2000-12-01

    The effect of the full moon on human behaviour, the so-called 'Transylvania hypothesis', has fascinated the public and occupied the mind of researchers for centuries. The aim of the present study was to determine whether or not there was any change in general practice consultation patterns around the time of the full moon. We analysed data from the fourth national morbidity study of general practice. The data set was split into two groups and analysed separately: consultations on ordinary weekdays and consultations on weekends and bank holidays. The data were split randomly into two equal sets, one for model building and one for model validation. The lunar cycle effect was assumed to be sinusoidal, on the grounds that any effect would be maximal at the time of the full moon and decline to the new moon, following a cosine curve (with a period of 29.54 days, the mean length of a lunar cycle). There was a statistically significant, but small, effect associated with the lunar cycle of 1.8% of the mean value [95% confidence interval (CI) 0.9-2.7%]. This equates to an average difference between the two extremes during the cycle of 3.6%. For this data set, this accounts for 190 (95% CI 95-285) more consultations on days at the peak of the cycle compared with those at the bottom of the cycle, or, put another way, about three consultations per practice. We can speculate neither as to what the nature of these moon-related problems may be, nor as to the mechanisms underpinning such behaviour. However, we have confirmed that it does not seem to be related to anxiety and depression.

  15. REMINDER FROM MEDICAL SERVICE

    CERN Multimedia

    Service Médical

    2000-01-01

    For medical problems, we would like to remind all personnel working on the CERN sites, be they staff or from outside firms, that they are welcome at the Infirmary, building 57, ground floor.For information, call the Nurses- on Telephone73802- by electronic mailInfirmary.Service@cern.chMarion.Diedrich@cern.chJanet.Doody@cern.chMireille.Vosdey@cern.chMedical Service

  16. Striking variations in consultation rates with general practice reveal family influence

    Directory of Open Access Journals (Sweden)

    Spreeuwenberg Peter

    2007-01-01

    Full Text Available Abstract Background The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21. Methods Data were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families. Results In almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background. Conclusion Family

  17. The Missing Evaluation at the End of GP’s Consultation

    Directory of Open Access Journals (Sweden)

    Maisa Kuusela

    2013-01-01

    Full Text Available Evaluation at the end of a consultation is an element of a successful encounter. The doctor should inquire if patient’s expectations were fulfilled and sum up the information given, the examinations performed, and the decisions made with the patient. This way the patient would be fully aware of what has been decided and that the problems and expectations of the patient had been taken into account. Twenty consultations of four general practitioners (GPs in Finland were videotaped. The doctors were men and women, two of them had a long experience and two were trainees in general practice. The data (videotapes, questionnaires, and interviews were analysed by multiple research methods with investigator and methodological triangulation. MAAS-Global Rating List was used as an assessment tool. The evaluation of the consultation was often missing or having shortages; only one-third was assessed to be better than doubtful. The assessments done by experienced GPs and the medical student were similar. According to the result of this study as well as the information in the current literature, doctors in all periods of their career should repeatedly be reminded about the importance of the evaluation at the end of the consultation.

  18. What Else? The Basics and Beyond for Effective Consultations with Youth with Special Healthcare Needs

    Directory of Open Access Journals (Sweden)

    April S. Elliott

    2017-10-01

    Full Text Available Youth with special healthcare needs (YSHCN require medical support for disease management and equally require that providers be responsive to their ever-changing and sometimes unique psychosocial and developmental needs. This paper reviews the fundamentals of adolescent consultation reminding the reader that YSHCN are, after all, still youth with the same basic needs as their healthy peers. Beyond the basics, consultations with this population are characterized by complexities which are best managed by providers who can nimbly adjust their clinical stance. In non-urgent clinical scenarios, clinicians can adopt a coaching stance which we introduce and expand upon in this paper. Characterized by the five elements of non-judgment, curiosity, empathy, openness, and flexibility, the coaching stance can be adopted without specific training. We demonstrate its application using TGROW (Topic, Goal, Reality, Options and Wrap Up, a coaching framework that holds promise for use in clinical settings. Consultants may consider incorporating the coaching stance and TGROW into their practice repertoire, as both may be particularly helpful when consulting with adolescents with chronic illness.

  19. Outreach surgical consulting services in North East Victoria.

    Science.gov (United States)

    Chittleborough, Timothy John; Lourensz, Kaleb; Elliott, Matthew; Thomas, Peter; Franzi, Stephen

    2013-12-01

    There is a paucity of data regarding the provision of consultative outreach specialist surgical services to rural areas. This paper aims to describe a model of outreach consultative practice to deliver specialist surgical services to rural communities. Analysis of prospectively collected data for consultations in a three month period for two surgeons based in Wangaratta. Two surgeons in regional Victoria based in Wangaratta, North East Victoria, conducting outreach consultations to Beechworth, Benalla, Bright and Mansfield. All patients seen in consultations over a 3-month period. Patient workload, casemix of presenting complaint, consultation outcome including plan for surgical procedure. Outreach surgical consulting was associated with a higher proportion of new consultations, and there was trend towards being more likely to result in a surgical procedure than consultations in the base rural centre. Outreach surgical consulting provides surgeons with a larger referral base and provides communities with better access to local specialists. Outreach practice should be encouraged for surgeons in regional centres. © 2013 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

  20. 门诊疑难病会诊流程再造%Complicated Cases consultation process reengineering in outpatient clinic

    Institute of Scientific and Technical Information of China (English)

    闻智; 蒋艳峰

    2011-01-01

    目的 探讨疑难病会诊模式,优化会诊流程.方法 回顾分析我院493份疑难病会诊病例及传统疑难病会诊模式,发现问题,提出解决方案.结果 对传统疑难病会诊流程再造,开发出疑难病会诊信息系统.结论 传统的疑难病会诊模式难以满足疑难病人就诊特色需求,不利于护士分诊.通过疑难病会诊流程的再造,借助信息系统可以提高护士疑难病分诊水平,提高护理工作效率,优化医院资源配置,满足疑难病病人就医.%Objective To discuss the complicated disease consultation pattern and optimize consultation process. Methods to retrospectively analyze 493 medical records of complicated disease consultation and conventional consultation pattern, try to find problems and rebuild a new way of complicated cases consultations. Results We find the way to reengineer traditional difficult disease consultation process and build consultation process systems on difficult disease. Conclusions The traditional model can not meet the demand of outpatient with difficult and complicated disease, and it is not conducive to nurse triage. The difficult disease consultation process reengineering can help improve the level of nurse triage and work efficiency,optimize the allocation of hospital resources to satisfy outpatients with difficult disease.