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Results for “Interdisciplinary Communication”

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At least 397 records · Page 22Linked to original sources
PubMed2006

Solitary intraductal papilloma of the breast--a diagnostic dilemma and the role of conferencing between surgeons and cytologist.

A 40 year female, presented with the complaints of spontaneous, sticky, blood stained discharge from the nipple of the left breast since 6 months. On examination there was no lump palpable in either breast. Cytology of the nipple discharge (ND) showed scanty cellularity consisting of tight papillary clusters of ductal cells in a hemorrhagic and inflammatory background. The nuclei were bland and showed degenerative atypia. Mammography showed no significant lesion. Our patient underwent microdochechtomy. Histopathology showed intraductal papilloma. Limitations of cytology must be kept in mind by both, the pathologist and the surgeon. The cytological diagnosis of a papillary tumor is provisional and the definitive diagnosis must await histological examination. In view of rarity of this lesion, combined with the overlapping of cytologic features in benign and malignant papillary lesions, conferencing and communication with the surgeon should be an integral part of patient evaluation and management. In our case this approach resulted in less radical excision of breast tissue.

Adult↗
PubMed2005

Audit of nutritional guidelines for head and neck cancer patients undergoing radiotherapy.

BACKGROUND: Head and neck cancer patients being treated with radiotherapy are at an increased risk of malnutrition due to the severe side-effects, e.g. mucositis, odynophagia and xerostomia, impacting on the ability to eat and drink. Effective dietetic management involves identifying those patients malnourished or at risk of becoming so and incorporating nutritional intervention into their treatment plan. The use of gastrostomy tubes in this patient group has been shown to be acceptable. By placing them prophylactically, the aim is to prevent a disruption to treatment and avoid an unnecessary admission for feeding. This audit was carried out to determine whether the implementation of locally produced nutritional guidelines improved the dietetic management of this patient group. METHOD: A prospective audit tool was used to collect data on 32 head and neck cancer patients undergoing radiotherapy. Data was collected weekly during the course of treatment and compared with data from previous audits. Weight change was the nutritional outcome measured. RESULTS: More patients underwent combined treatment (radiotherapy postoperatively or with concurrent weekly chemotherapy) when compared with previous audits. However, implementation of the guidelines appeared to contribute to an improvement in dietetic management, as fewer patients lost weight over the course of radiotherapy and there were no admissions for feeding. The presence of a dietitian at the multidisciplinary head and neck clinic improved access and communication and this is also likely to have contributed to the improved management. CONCLUSIONS: Implementation of the guidelines led to an improvement in the nutritional management of this patient group. Implementation may be more likely if a dietitian is present at the combined head and neck clinic.

Combined Modality Therapy↗
PubMedDate not supplied

Bioethics and the contemporary Jewish community.

David Novak takes up the methodological issue of how substantive religious perspectives can be communicated in a pluralistic society. Novak notes that while "secularism" was historically welcomed by the Jewish community, Jewish thinkers now likewise face the challenge of speaking out of a tradition to a secular audience. Novak holds up Jewish-Christian dialogue as a model for constructing a public philosophy.

Bioethics↗
PubMed2004

The impact of ICT on communication in healthcare.

Communication processes are pervasive in the daily practice of health professionals. Reorganizing these daily practices by introducing ICT, inevitably effects one or more communication processes. Understanding exactly what these effects are, is a major problem in designing and implementing ICT-applications. In this paper we present an analysis of these effects, based on a theory of communication processes. The concept of 'decoupling' is pivotal in our analysis. Based on the identified effects, and some preconditions that have to be met in order for these effects to take place, we derive a number of guidelines for reorganizing communication processes by means of applying ICT. The application of these guidelines will be demonstrated and discussed in the context of the reorganization of a team conference at the Rehabilitation Clinic of the Rheumatology Department of the Leiden University Medical Center (RCRD/LUMC).

Information Theory↗
PubMed2006

[Education for medical teamwork in Shinshu University].

Both students of health sciences (medical technology, nursing science, physical therapy, and occupational therapy) and medical students learn medical teamwork in the primary stage by joint practice in Shinshu University. The aim of this class is for students that will become medical staff to increase their necessary communication skills for medical teamwork in addition to understanding the mutual medical professional fields in a medical institution. The 242 students of the medical department (147 students of health sciences and 95 students of medicine) take 15 classes during their first term as freshers. One teacher takes charge of a group consisting of 14 students for tutorials by mutually cooperation between teachers of medicine and health sciences. Positive relationships are expected to develop in the group, raising sociality and ethics so that both students of health science and medicine experience interdisciplinary discussion in small groups as an ideal method for continuing health care in times of poor knowledge of medicine and health care.

Clinical Competence↗
PubMed2002

Integrating information for better environmental decisions.

As more is learned about the complex nature and extent of environmental impacts from progressive human disturbance, scientists, policy analysts, decision makers, educators, and communicators are increasingly joining forces to develop strategies for preserving and protecting the environment. The Eco-Informa Foundation is an educational scientific organization dedicated to promoting the collaborative development and sharing of scientific information. The Foundation participated in a recent international conference on environmental informatics through a special symposium on integrating information for better environmental decisions. Presentations focused on four general themes: (1) remote sensing and data interpretation, including through new knowledge management tools; (2) risk assessment and communication, including for radioactively contaminated facilities, introduced biological hazards, and food safety; (3) community involvement in cleanup projects; and (4) environmental education. The general context for related issues, methods and applications, and results and recommendations from those discussions are highlighted here.

Congresses as Topic↗
PubMed2006

Medical care of employees long-term sick listed due to mental health problems: a cohort study to describe and compare the care of the occupational physician and the general practitioner.

OBJECTIVES: To describe medical management by the general practitioner (GP) and occupational physician (OP) of workers sick listed due to mental health problems, and to determine agreement in diagnosis, main cause of sickness absence and obstacles in return to work. METHODS: A cohort of 555 employees being sick listed for 12 to 20 weeks due to mental health problems was recruited and followed for 1 year. These employees were interviewed about their mental health and contacts with GP, OP, other specialists and employer. In addition, the GP and/or the OP of 72 employees were interviewed about the medical diagnosis and management. RESULTS: Most employees sick listed for 12-20 weeks visited their GP and OP. According to the employees most interventions applied by the GP were medical interventions, such as referral of employees and prescription of medical drugs. Working conditions were seldom discussed by the GP and work-related interventions were never applied. Most interventions applied by the OP were work-related interventions and/or contact with the employer. The OP more often talked about working conditions and conflicts. According to the employees, the communication between GP and OP only took place in 8% of the cases. Agreement in the diagnosis, main cause of sickness absence, and obstacles in return to work reported by the GPs and OPs of the same employee was poor. In addition, similarity in reported diagnosis by GP and/or OP and the employees' scores on valid questionnaires on (mental) health was limited. CONCLUSIONS: The lack of communication and agreement by Dutch GPs and OPs in medical diagnosis and management of employees long-term sick listed due to mental health problems are indicators of sub-optimal medical treatment and return-to-work strategies.

Adult↗
PubMed2003

Comments on Ortwin Renn's article 'Hormesis and risk communication': considerations about uncertainity, ignorance and governance.

After acknowledging Renn's careful investigation and valuable insights, this paper expands on some issues that have been somewhat neglected in his account. It addresses the relationship between risk, uncertainity and ignorance in risk assessment, focusing in particular on the need to recognize that framing assumptions condition all subsequent steps. Subsequently, it discusses the implications for risk communication in the case of hormesis. The author maintains that problems of risk are strictly and irremediably intertwined with problems of governance. Therefore, she is doubtful that regulatory agencies would promote, and the public would welcome, modifications in current regimes on the basis of still limited and debated evidence of good.

Animals↗
PubMed2004

Multispecialty telephone and e-mail consultation for patients with developmental disabilities in rural California.

The University of California (UC), Davis Health System, and California Department of Developmental Services (CDDS) developed the Physician Assistance, Consultation and Training Network (PACT Net) to assist primary-care providers (PCPs) care for patients with developmental disabilities in rural California. This manuscript describes PACT Net, a warm line using phone and e-mail, and its multispecialty panel. A pilot study evaluated whether or not PCPs needed such a consultation service, whether or not it assisted them in providing care, and their overall satisfaction with the service. PCPs were informed on how to request a consultation. Data were collected from patients (demographics), PCPs (satisfaction with preexisting consultation availability and quality, PACT Net consultation reason, preferred mode of contact, duration, and, satisfaction), and specialists (ease, quality of request, and satisfaction). Satisfaction was measured prospectively using a 7-point Likert scale. Data were collected on 30 consultations, 28 by telephone and 2 by e-mail; other data were by combined methods. The average duration of consultation was 47 minutes, and 24 responses occurred within one business day. The top three services requested for consultation were psychiatry (e.g., management of behavioral disturbance), medical genetics (diagnosis), and gastroenterology (miscellaneous). PCPs rated baseline satisfaction with: (1) pre-existing local services at 3.37, (2) timeliness of the PACT Net consultation at 5.45, (3) quality of the communication at 6.3, and (4) overall quality and utility of the consultation at 6.2. Specialists rated the quality of the communication at 6.45, and the ease of the service at 6.46. Phone and e-mail consultation appears satisfactory to PCPs and specialty providers as a way to enhance specialty input to rural patients.

Adolescent↗
PubMed2006

SBAR: a shared mental model for improving communication between clinicians.

BACKGROUND: The importance of sharing a common mental model in communication prompted efforts to spread the use of the SBAR (Situation, Background, Assessment, and Recommendation) tool at OSF St. Joseph Medical Center, Bloomington, Illinois. CASE STUDY: An elderly patient was on warfarin sodium (Coumadin) 2.5 mg daily. The nurse received a call from the lab regarding an elevated international normalized ratio (INR) but did not write down the results (she was providing care to another patient). On the basis of the previous lab cumulative summary, the physician increased the warfarin dose for the patient; a dangerously high INR resulted. ACTIONS TAKEN: The medical center initiated a collaborative to implement the use of the SBAR communication tool. Education was incorporated into team resource management training and general orientation. Tools included SBAR pocket cards for clinicians and laminated SBAR "cheat sheets" posted at each phone. SBAR became the communication methodology from leadership to the microsystem in all forms of reporting. DISCUSSION: Staff adapted quickly to the use of SBAR, although hesitancy was noted in providing the "recommendation" to physicians. Medical staff were encouraged to listen for the SBAR components and encourage staff to share their recommendation if not initially provided.

Hospitals, Community↗
PubMed2005

Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses.

AIMS AND OBJECTIVES: To study the perspectives of nurses on (i) the process of decision-making regarding the placement of feeding gastrostomies, (ii) their role in the process, (iii) the impact this participation has on them personally and (iv) gastrostomy placement in general. BACKGROUND: The decision to commit patients to long-term feeding using a gastrostomy tube can be very difficult, particularly when the anticipated benefits are uncertain. Strategies to improve such decision-making are required. Nurses are in an excellent position to provide valuable insights regarding this decision-making and their increased participation in this process might substantially improve it. DESIGN: A cross-sectional, exploratory design using in-depth semi-structured interviews and a self-administered questionnaire. METHODS: In-depth semi-structured interviews with 17 nurses experienced in percutaneous endoscopic gastrostomy decision-making were undertaken and analysed. RESULTS: Individuals making decisions regarding feeding gastrostomy placement were observed to be insufficiently informed regarding the device and the ramifications of its placement. Nurses were perceived to play an important, although underused, role in decisions to commit patients to long-term feeding. Participation in the making of these decisions may be stressful to nurses, particularly when the only result anticipated is the sustaining of a life of poor quality. Sixteen nurses reported that they would not want to have a gastrostomy for themselves if they were unable to maintain some quality of life. Strategies that could improve decision-making were suggested. CONCLUSIONS: Decision-making could be improved by providing better information to decision makers. A team-orientated approach and more active dialogue with regard to care planning among health professionals, especially between doctors and nurses is needed. Effective decisions regarding feeding gastrostomy placement require adequate resources, especially sufficient time for caregivers to communicate effectively with those who must make these decisions. RELEVANCE TO CLINICAL PRACTICE: The role of nurses in decision-making regarding commitments to long-term feeding using gastrostomy tubes could be effectively augmented.

Adult↗
PubMedDate not supplied

Inpatient consultation: results of a physician survey and a proposed improvement.

We undertook the current survey-based study to assess clinicians' views on the determinants of effective inpatient consultation and the existing process of inpatient consultation at the Cleveland Clinic Hospital. A 25-question survey developed for this study using Likert scale responses was completed by 181 (of 404 eligible addressees, a 45% response rate) members of the Cleveland Clinic staff in the divisions of medicine, surgery, and pediatrics. Ratings of the overall value of inpatient consultation reflected moderate satisfaction (mean 6.9 of possible 10). Types of consults that were most valued were those requesting a procedure and those seeking assistance in establishing a diagnosis and in interpreting data. Features deemed most important in making a consult excellent were legibility of the consultant's note, timeliness of the response (i.e., within 24 hours), and direct communication of the consult question. The data showed a trend indicating that physicians regarded the value of direct physician-to-physician communication more highly than they personally practiced such direct communication when requesting a consult. Study findings indicate the opportunity to improve the process of inpatient consultation by implementing measures that enhance direct physician-to-physician communication about the consult, ensure timeliness, facilitate identification of the appropriate consultants, and allow easier auditing. We propose a novel process for requesting inpatient consultations that extends currently available hospital information systems but offers a process improvement that warrants development.

Attitude of Health Personnel↗
PubMed2003

Understanding why GPs see pharmaceutical representatives: a qualitative interview study.

BACKGROUND: Doctors are aware of the commercial bias in pharmaceutical representative information; nevertheless, such information is known to change doctors' prescribing, and augment irrational prescribing and prescribing costs. AIM: To explore GPs, reasons for receiving visits from pharmaceutical representatives. DESIGN OF STUDY: Qualitative study with semi-structured interviews. SETTING: One hundred and seven general practitioners (GPs) in practices from two health authorities in the North West of England. RESULTS: The main outcome measures of the study were: reasons for receiving/not receiving representative visits; advantages/disadvantages in receiving visits; and quality of representative-supplied information. Most GPs routinely see pharmaceutical representatives, because they bring new drug information speedily; they are convenient and accessible; and can be consulted with a saving of time and effort. Many GPs asserted they had the skills to critically appraise the evidence. Furthermore, the credibility and social characteristics of the representative were instrumental in shaping GPs' perceptions of representatives as legitimate information providers. GPs also received visits from representatives for reasons other than information acquisition. These reasons are congruent with personal selling techniques used in marketing communications. CONCLUSIONS: The study draws attention to the social and cultural contexts of GP-representative encounters and the way in which the acquisition of pharmacological information within the mercantile context of representative visits is legitimated. This highlights the need for doctors to critically appraise information supplied by representatives in relation to other information sources.

Drug Industry↗
PubMed2004

A survey of GP attitudes to and experiences of email consultations.

Email is an accepted part of modern communication in business and education. The use of email could benefit communication between patients and healthcare professionals. Use of email within health care has been hampered by concerns about privacy, technical barriers, perceived fear of change and increased workload.Sixty-two general practitioners within Dundee in east Scotland responded to a questionnaire and indicated that they regularly used email for communication within their practices and with outside agencies, but rarely with patients. Many perceived a need to provide an email service for clinical enquiries and repeat prescription requests but felt constrained from doing so by a lack of an accepted system and workload concerns.

Attitude of Health Personnel↗
PubMed2004

The impact of structuring multidisciplinary team conferences mediated by ICT in the treatment of patients with rheumatic diseases.

Communication processes are pervasive in the daily practice of health professionals. Reorganizing these daily practices by introducing ICT, inevitably effects one or more communication processes. Understanding exactly what these effects are, is a major problem in designing and implementing ICT-applications. In this paper we present an analysis of these effects, based on a theory of communication processes. The concept of 'decoupling' is pivotal in our analysis. Based on the identified effects, and some preconditions that have to be met in order for these effects to take place, we derive a number of guidelines for reorganizing communication processes by means of applying ICT. The application of these quidelines will be demonstrated and discussed in the context of the reorganization of a team conference at the Rehabilitation Clinic of the Rheumatology Department of the Leiden University Medical Center (RCRD/LUMC), a multidisciplinary team care setting.

Health Personnel↗
PubMedDate not supplied

Waisman Center.

The Waisman Center MRDDRC supports behavioral, social, and biomedical research on human development, developmental disabilities, and neurodegenerative diseases. Examples of research conducted in each of the four MRDDRC units include: abnormalities in gene expression in human neuronal stem cells and progenitor cells from Down syndrome tissue (from the Molecular and Genetic Sciences Unit), language disorders in adolescents with Down syndrome and Fragile X syndrome (from the Communication Processes Unit); the development of selective visual attention during the first 6 months of life (from the Sensory and Cognitive Processes Unit); and the long-range effects of early intervention on special education placement, delinquency, and high school graduation rates (from the Social and Affective Processes Unit).

Academic Medical Centers↗
PubMed2005

The significance of a collaborative practice model in delivering care to chronically ill patients: a case study of managing diabetes mellitus in a primary health care center.

Non-communicable diseases, especially diabetes mellitus type two (DM2) constitute major health problems in Lebanon that have an adverse impact on health and health resources. Collaborative practice interventions may improve quality care of DM2 and reduce or delay complications. The purpose of this paper was to evaluate the impact of collaborative practice on the quality and cost of effective care for diabetic patients in a primary health care center. A chart audit review of 375 diabetic patients attending an inner city health center in Beirut (Lebanon) was conducted after three and a half years of collaborative practice intervention, which included guidelines for an interdisciplinary health team. Evaluation of the impact of collaborative practice was conducted on the process and outcome of care. The results indicated a high level of enthusiasm, support and the development of team spirit at the process level. At the outcome level there was improvement in documentation, increase in patient recruitment, increase in continuity of care, improvement of glycemic control and decreased cost. In conclusion collaborative practice interventions improved process and outcome variables for diabetic patients. It is suggested that this model could be developed for use in the care of other chronic diseases.

Chronic Disease↗
PubMed2004

Harnessing technology and collaboration for an online ethnogeriatric educational resource.

The paper describes the development and testing of a Web-based educational resource for usability and acceptability by health care providers who care for ethnic older adults. The work was undertaken as a dissertation project. The purpose of the Website is to provide on-demand ethnogeriatric information to enhance provider-patient interaction. Focus groups of clinicians and ethnic older adults were used in order to identify content relevant to the care of frail ethnic older adults. Collaboration with the Stanford Geriatric Education Center, On Lok SeniorHealth Services, Inc., Pepperdine University Graduate School of Education, and a network of virtual consultants provided support to the project. The site contains information on 15 cultures, 12 religions, and 6 ethnic minority cohort groups. Testing by snowball sampling generated survey data from 96 respondents, consisting of general practitioners (24%), pediatric specialists (20%), and geriatric specialists (18%). The Website was considered useful for provider-patient communication (77%) and would be recommended to others (99%). The Web-based information resource, called "Diversity, Healing, and Healthcare," currently exists as a resource rather than as a defined learning module and can be accessed at http://www.gasi. org/diversity.htm.

Attitude of Health Personnel↗