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BMC Family Practice Aug 2017Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by... (Observational Study)
Observational Study
BACKGROUND
Anal disorders are largely underestimated in general practice. Studies have shown patients conceal anal symptoms leading to late diagnosis and treatment. Management by general practitioners is poorly described. The aim of this study is to assess the prevalence of anal symptoms and their management in general practice.
METHODS
In this prospective, observational, national study set in France, all adult patients consulting their general practitioner during 2 days of consultation were included. Anal symptoms, whether spontaneously revealed or not, were systematically collected and assessed. For symptomatic patients, the obstacles to anal examination were evaluated. The general practitioner's diagnosis was collected and a proctologist visit was systematically proposed in case of anal symptoms. If the proctologist was consulted, his or her diagnosis was collected.
RESULTS
From October 2014 to April 2015, 1061 patients were included by 57 general practitioners. The prevalence of anal symptoms was 15.6% (95% CI: 14-18). However, 85% of these patients did not spontaneously share their symptoms with their doctors, despite a discomfort rating of 3 out of 10 (range 1-5). Although 65% of patients agreed to an anal examination, it was not proposed in 45% of cases with anal symptoms. Performing the examination was associated with a significantly higher diagnosis rate of 76% versus 20% (p < 0.001). Proctologist and general practitioner diagnoses were consistent in 14 out of 17 cases.
CONCLUSIONS
Patients' concealed anal symptoms are significant in general practice despite the impact on quality of life. Anal examination is seldom done. Improved training of general practitioners is required to break the taboo.
Topics: Adult; Aged; Anus Diseases; France; General Practice; Humans; Male; Middle Aged; Physical Examination; Prevalence; Prospective Studies
PubMed: 28774265
DOI: 10.1186/s12875-017-0649-6 -
Behavior Analysis in Practice Sep 2022Saini et al. (2019) urged caution with respect to the use of practical functional assessment (PFA) procedures to inform behavioral treatment when they found that...
Saini et al. (2019) urged caution with respect to the use of practical functional assessment (PFA) procedures to inform behavioral treatment when they found that responses to an open-ended caregiver interview were only somewhat reliable and showed moderate to weak correspondence with analog functional analyses. Because the practitioner's goal in conducting any functional assessment process is to inform the successful treatment of problem behavior, we replicated and extended Saini et al. by (a) evaluating the reliability of hypotheses gleaned from two independent PFA processes for each of four children, (b) conducting treatment informed by a randomly assigned PFA, and (c) determining the extent to which potentially different levels of reliability impacted the treatment utility of the PFA process. Results indicated that the reliability of the PFA process varied depending on the stringency with which it was evaluated. However, treatments developed from randomly determined PFA processes produced efficacious outcomes on problem behavior and targeted social skills that transferred to the context designed from the other PFA process in all evaluations, suggesting that the PFA has strong treatment utility despite parts of the process having ambiguous levels of reliability. We discuss implications for practitioners tasked with treating severe problem behavior.
PubMed: 36465598
DOI: 10.1007/s40617-021-00665-6 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2021The aim: To analyse human right issues in health care during the SARS CoV-2 pandemic from the perspective of patients' and medical practitioner's rights.
OBJECTIVE
The aim: To analyse human right issues in health care during the SARS CoV-2 pandemic from the perspective of patients' and medical practitioner's rights.
PATIENTS AND METHODS
Materials and methods: Multidisciplinary research will be conducted as part of national as well as international health care policy documents, international human right instruments, including case law decisions, and also major scientific articles on human rights from the healthcare perspective will be analysed. The comparative, Research synthesis method and systemic analyses will be made during the research.
RESULTS
Results: The study confirmed that human right issues in the context of health care in case of Patient triage become relevant and transformed. The situation of COVID-19 has created new precedents for human rights, with a particular impact on the rights of doctors and patients.
CONCLUSION
Conclusions: Human rights from the healthcare perspective become the topical issue during the COVID 19 pandemic. The legal practice in human rights had several transformations and it provides new challenges from patients as well as medical practitioners' rights. Important problem, from the ethical -legal perspective is the Patient's triage. The situation on patients triage or ranking shows importance and possibility of each member state to act fast, taking into consideration fast changing situation in medical health system. Sorting patients whose lives are at risk according to certain criteria for assessing their lives is not acceptable. In order to reduce events of violations of human rights during COVID 19 in healthcare, the emphasis should be placed for explanation of decisions made in state level.
Topics: COVID-19; Delivery of Health Care; Human Rights; Humans; SARS-CoV-2; Triage
PubMed: 34537739
DOI: No ID Found -
Journal of Perioperative Practice Apr 2018Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential... (Review)
Review
Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential for scrub practice, because they facilitate anticipation of the surgeon's requirements and promote appropriate communication behaviours. This literature review analyses the factors that may influence a scrub practitioner's use of non-technical skills during surgery. Recommendations are made that are intended to improve their use by reducing behavioural variations during surgery.
Topics: Clinical Competence; Communication
PubMed: 29611790
DOI: 10.1177/1750458918762315 -
Medicine and Pharmacy Reports Oct 2019The decision-making process when restoring a non-vital tooth is influenced by multiple factors. This study aimed to survey the dentists' preferences regarding cast...
BACKGROUND AND AIMS
The decision-making process when restoring a non-vital tooth is influenced by multiple factors. This study aimed to survey the dentists' preferences regarding cast post-and-core and fiber post techniques for the reconstruction of non-vital teeth and to identify a correlation between reconstruction technique and practitioners characteristics, or dental characteristics.
METHODS
The survey instrument was a questionnaire, which included a with questions regarding the practitioner's profile (gender, age, years of experience, pattern and location of practice, etc.) and the dental characteristics (anterior or posterior position of the tooth on the arch, the amount of dental remaining tissues, etc.) and a , containing more specific questions regarding the manufacture and performance of root-coronal reconstructions.
RESULTS
Among the surveyed practitioners (n=35), 69.7% use more often cast post-and-core reconstructions (CPR) while 30.3% choose fiber post reconstructions (FPR). No difference in the reconstruction type was observed regarding patient's age (p=0.23) or gender (p=0.092). The para-function criterion was considered important by 8.23% of the participants. When deciding the type of the root-coronal reconstruction depending on the remaining dentine walls, CPRs are significantly more frequently used in posterior areas (p=0.043) or when para-functional habits exist (p=0.022).
CONCLUSION
Cast post-and-core represent the most frequently used type of reconstruction for non-vital teeth. Fiber post reconstructions are indicated in the aesthetic zone and when the amount of healthy remaining dental structure is higher.
PubMed: 31750440
DOI: 10.15386/mpr-1148 -
Journal of Applied Gerontology : the... Jul 2020This study examined post-acute care (PAC) rehabilitation practitioner's perspectives on communication. This is a secondary data analysis of a larger qualitative study,...
This study examined post-acute care (PAC) rehabilitation practitioner's perspectives on communication. This is a secondary data analysis of a larger qualitative study, which included PAC rehabilitation provider ( = 99) focus groups that were held in a purposive sample of 13 skilled nursing facilities (SNFs). Participants emphasized the importance of bidirectional communication between rehabilitation and nursing. Three themes were identified: (a) communication between rehabilitation practitioners and registered nurses or licensed practical nurses, (b) communication between rehabilitation practitioners and certified nursing assistants, and (c) communication between rehabilitation practitioners and nursing leaders. Two subthemes within each of the three themes were further characterized to understand how information was exchanged: (a) static communication and (b) action-oriented communication. Our findings highlight opportunities for better communication in PAC between rehabilitation practitioners and nursing and thus lay a foundation for future efforts to improve care coordination through enhancing interdisciplinary communication.
Topics: Communication; Focus Groups; Humans; Nurses; Rehabilitation; Skilled Nursing Facilities; Subacute Care
PubMed: 30141715
DOI: 10.1177/0733464818794148 -
Public Health Research & Practice Jun 2021Study objectives and importance: The study aimed to explore how a 'self-in-the-system' approach was understood and applied by Healthy Together Community (HTC)...
Study objectives and importance: The study aimed to explore how a 'self-in-the-system' approach was understood and applied by Healthy Together Community (HTC) practitioners, as part of Healthy Together Victoria's (HTV) systems approach to community-level health promotion. Self-in-the-system tactics were a means of systems practice within HTV, where practitioners viewed their connections to others as parts of the systems that surround them. It enabled them to intervene via exerting influence, by drawing upon relationships to leverage what people can contribute to achieve change. Study type and methods: This qualitative research included 31 primary semistructured interviews. The initial participants were identified using purposive sampling and subsequent participants were nominated via snowball recruitment. The interview questions focused on participants' understanding of systems thinking and about how it had been developed and applied in HTCs. The interviews were recorded and transcribed verbatim. Inductive thematic analysis was based on Braun and Clarke's six-phase analysis framework. Results: The research findings show that some of the HTC practitioners viewed themselves as part of the prevention system and were able to draw upon their relationships to achieve change. They had invested time to develop trusted connections upon which to engage and encourage cooperation. The notion of a 'prevention change agent' developed, referring to practitioners who used their influence to achieve HTC goals. This practical know-how was developing in HTCs as people were able to describe the concept, rather than provide examples of working in this way. Conclusion: Within a systems approach to community-level health promotion, a practitioner's capacity to identify their role in complex adaptive systems and their ability to influence others are potentially powerful skills to facilitate change. Self in the system is a developing skill for systems practice for prevention and it may add more systemic ways of working compared with traditional programmatic methods.
Topics: Government; Health Personnel; Health Promotion; Humans; Interpersonal Relations; Interviews as Topic; Public Health; Qualitative Research; Victoria
PubMed: 34104934
DOI: 10.17061/phrp30122005 -
Journal of Intellectual Disabilities :... May 2023In Ireland, the provision of behavior support services has developed following the introduction of Health Information and Quality Authority (2013) standards and the...
In Ireland, the provision of behavior support services has developed following the introduction of Health Information and Quality Authority (2013) standards and the regulation of Positive Behavior Support (PBS) under the Health Act (2007). The purpose of this study was to explore what factors facilitate and act as barriers to implementation of behavioral recommendations in Intellectual Disability organizations from the practitioner's perspective. Twelve interviews were carried out, audio recorded, transcribed and analysed using Braun and Clarke's (2006) Thematic Analysis. One superordinate theme (administrator support), four themes (values, resources, relationships and implementation of consequences) and five sub-themes (staff turnover and burnout, training and knowledge, time and physical contact, relationships between practitioners and staff and staff and service users) were identified, all interconnected in the implementation process. A common thread reflected throughout the themes, was the practitioner's acknowledgment of barriers overpowering facilitation which resulted in a less than optimum implementation of PBS.
PubMed: 37230757
DOI: 10.1177/17446295231178073 -
Journal of Advances in Medical... Oct 2015Leadership and management are two expected features and competencies for general practitioners (GPs). The purpose of this study was leadership and management curriculum...
INTRODUCTION
Leadership and management are two expected features and competencies for general practitioners (GPs). The purpose of this study was leadership and management curriculum planning for GPs which was performed based on Kern's curriculum planning cycle.
METHODS
This study was conducted in 2011- 2012 in Iran using an explanatory mixed-methods approach. It was conducted through an initial qualitative phase using two focus group discussions and 28 semi-structured interviews with key informants to capture their experiences and viewpoints about the necessity of management courses for undergraduate medical students, goals, objectives, and educational strategies according to Kern's curriculum planning cycle. The data was used to develop a questionnaire to be used in a quantitative written survey. Results of these two phases and that of the review of medical curriculum in other countries and management curriculum of other medical disciplines in Iran were used in management and leadership curriculum planning. In the qualitative phase, purposeful sampling and content analysis with constant comparison based on Strauss and Corbin's method were used; descriptive and analytic tests were used for quantitative data by SPSS version 14.
RESULTS
In the qualitatively stage of this research, 6 main categories including the necessity of management course, features and objectives of management curriculum, proper educational setting, educational methods and strategies, evolutionary method and feedback result were determined. In the quantitatively stage of the research, from the viewpoints of 51.6% of 126 units of research who filled out the questionnaire, ranked high necessary of management courses. The coordination of care and clinical leadership was determined as the most important role for GPs with a mean of 6.2 from sample viewpoint. Also, team working and group dynamics had the first priority related to the principles and basics of management with a mean of 3.59. Other results were shown in the paper.
CONCLUSION
Results of this study indicated the need to provide educational programs for GPs; it led to a systematic curriculum theory and clinical management using Kern cycle for general practitioner's discipline. Implementation and evaluation of this program is recommended.
PubMed: 26457312
DOI: No ID Found -
Bundesgesundheitsblatt,... Mar 2021The German National Health Portal, which is currently in preparation, is intended to provide evidence-based health information. It seems sensible to reflect on... (Review)
Review
BACKGROUND
The German National Health Portal, which is currently in preparation, is intended to provide evidence-based health information. It seems sensible to reflect on development perspectives in order to be able to estimate application horizons as well as usage and impact potential of the portal under the conditions of the health system so that specific additional value can be generated.
OBJECTIVES
Considering the implementation experience of other European countries, the current status of the project and the perspective of political decisionmakers and medical practitioners are outlined. Fundamental recommendations on how a national health portal can be successfully established, especially with regard to primary care, are derived from the analysis.
METHODS
On the basis of a literature search and two preliminary studies, the article examines the development categories in which a national health portal could be designed in the future.
RESULTS
Based on the overview, a number of dimensions appear to be decisive for the planning and implementation process of a national health portal. These relate to embedment in a higher-level e‑health strategy, convergence and integration measures with regard to evidence-based information, ensuring sufficient findability on the Internet, a substantive focus that addresses target groups, a functional structure, as well as sponsorship and involvement of healthcare actors.
CONCLUSIONS
An evidence-based portal can be a valuable instrument to better educate patients, strengthen the doctor-patient relationship, and advance the digitalization of the healthcare system more strongly. Therefore, a sufficient degree of innovation and integration ability as well as awareness and visibility within the health system should be ensured.
Topics: Europe; General Practitioners; Germany; Humans; Physician-Patient Relations
PubMed: 33580814
DOI: 10.1007/s00103-021-03288-y