Consultant Advice Research Articles

Targeted Medical Consultation and Lifestyle Modification Advice for the Improvement of Quality of Life and Daily Habits in Gynaecological Patients: A Pilot Study.

Introduction Lifestyle factors account for a considerable part of the etiology of several metabolic disorders and many chronic benign and malignant conditions in the gynecological patient in particular. Lifestyle modification interventions offered within the context of gynecological care and endorsed by a medical practitioner have the potential to more strongly motivate patients to enact long-lasting changes. Methods A randomized pilot study was performed on 60 gynecological patients, utilizing simple lifestyle information and advice, supplementing routine consultation. Quality of life, dietary, exercise and smoking related habits were assessed at enrolment and then at 15, 30, and 60 days into the study. Results Quality of life significantly improved for the study group at 15- and 30-day assessments, but the difference was not maintained at 60 days. Participants in the study group significantly increased weekly fruit portions, but no differences were evident for vegetable, red meat, and dessert portions. Weekly exercise rate and exercise duration were higher in the study group, as was the adoption of a more physically active routine for non-exercising participants. Finally, the study group smokers managed to significantly reduce the number of daily cigarettes, but this was a small subgroup of the overall participants. Conclusion The findings of the present study indicate the potential of lifestyle interventions endorsed by a trusted medical practitioner for improving quality of life and daily habits in the gynecological patient. A larger, follow-up study is necessary to confirm these findings and further refine the interventions used, in order to maximize effectiveness.

Examining the impact of personalization and carefulness in AI-generated health advice: Trust, adoption, and insights in online healthcare consultations experiments

Artificial intelligence (AI) technologies, exemplified by health chatbots, are transforming the healthcare industry. Their widespread application has the potential to enhance decision-making efficiency, improve the quality of healthcare services, and reduce medical costs. While there is ongoing discussion about the opportunities and challenges brought by AI, more needs to be known about the public's attitude towards its use in the healthcare domain. Understanding public attitudes can help policymakers better grasp their needs and involve them in making decisions that benefit both technological development and social welfare. Therefore, this study presents evidence from two between-subjects experiments. This study aims to compare the public's adoption and trust levels in health advice provided by human vs. AI doctors and explore the potential effects of personalization and carefulness on the public's attitudes. Experimental designs adopt a trust-centered, cognitively and emotionally balanced perspective to study the public's intention to adopt AI. In Experiment 1, the experimental conditions involve the types of decision-makers providing online consultation advice, either AI or human doctors. In Experiment 2, the experimental conditions involve varying levels of perceived personalization and carefulness (high vs. low). A total of 734 participants took part in the study. They were randomly assigned to one of the intervention conditions and responded to manipulation checks after reading the materials. Using a seven-point Likert-type scale, participants rated their cognitive and emotional trust levels and intention to adopt the advice. Partial Least Squares Structural Equation Modeling (PLS-SEM) is conducted to estimate the proposed theoretical perspective. Qualitative interviews on both real-world and AI-generated treatment recommendations further enriched the understanding of public perceptions.The results show that AI-generated advice is generally slightly less trusted and adopted by the public. However, a noticeable inclination towards AI-generated advice emerges when AI demonstrates proficiency in understanding individuals' health conditions and providing empathetic consultations. Further analyses confirm the mediating influence of emotional trust between cognitive trust and adoption intention. These findings provide deeper insights into the process of adoption and trust formation. Moreover, they offer guidance to digital healthcare providers, empowering them with the knowledge to co-design AI implementation strategies that cater to the public's expectations.

Guidelines for conscientious objection in Spain: a proposal involving prerequisites and protocolized procedure

Healthcare professionals often face ethical conflicts and challenges related to decision-making that have necessitated consideration of the use of conscientious objection (CO). No current guidelines exist within Spain’s healthcare system regarding acceptable rationales for CO, the appropriate application of CO, or practical means to support healthcare professionals who wish to become conscientious objectors. As such, a procedural framework is needed that not only assures the appropriate use of CO by healthcare professionals but also demonstrates its ethical validity, legislative compliance through protection of moral freedoms and patients’ rights to receive health care. Our proposal consists of prerequisites of eligibility for CO (individual reference, specific clinical context, ethical justification, assurance of non-discrimination, professional consistency, attitude of mutual respect, assurance of patient rights and safety) and a procedural process (notification and preparation, documentation and confidentiality, evaluation of prerequisites, non-abandonment, transparency, allowance for unforeseen objection, compensatory responsibilities, access to guidance and/or consultative advice, and organizational guarantee of professional substitution). We illustrate the real-world utility of the proposed framework through a case discussion in which our guidelines are applied.

Patients’ and clinicians’ views on the appropriate use of safety-netting advice in consultations—an interview study from Sweden

BackgroundA promising approach to manage clinical uncertainty and thereby reduce the risk of preventable diagnostic harm is to use safety-netting advice (ie, communicating structured information to patients about when and...

Psychiatric consultation: Characteristics, satisfaction, and perceived opportunities among referrers to a 1-time service.

To further understand and optimize primary care provider (PCP) referrals to a 1-time psychiatric consultation service by developing profiles of PCP referrers, assessing PCP satisfaction with the service, and determining intervention opportunities. Secondary analysis of a referral database and subsequent cross-sectional survey of referrers. Winnipeg, Man. All family physicians who had made at least 1 referral in 2017 to the Centralized Psychiatric Consultation Service for Adults, a 1-time consultation service. Referral frequency, individual and practice characteristics, satisfaction with the Centralized Psychiatric Consultation Service for Adults, and subjective drivers of referral activity were assessed. Interest in a range of intervention opportunities to increase mental health knowledge and support were also examined. Of the 403 family physicians who referred patients to the consultation service in 2017, a total of 111 (27.5%) responded to the survey. Among all referrers, 287 (71.2%) were low referrers (1 to 4 referrals), 65 (16.1%) were moderate referrers (5 to 9 referrals), and 51 (12.7%) were high referrers (≥10 referrals). Solo practice (P=.04) and no access to collaborative mental health services (P<.001) were significantly associated with being a high referrer. Roughly 26.3% of low referrers, 29.2% of moderate referrers, and 15.4% of high referrers were satisfied with wait times for the service. Higher referrers did not identify a lack of comfort with providing psychiatric care as a driver of referrals; more indicated that they had a high volume of patients with mental health needs, that there was a lack of access to alternative services, and that patients sometimes requested referral. Overall, more than 40% of respondents expressed interest in a mental health care navigator, hard-copy resource information, and rapid access to consultation advice via telephone or an electronic platform. There was less interest in other proposed interventions. We found referrers to the Centralized Psychiatric Consultation Service for Adults to be clustered based on specific practice characteristics, as well as provider-patient factors. Overall, satisfaction with the service was fair and PCPs were not highly interested in a variety of proposed interventions. Future studies should explore how useful 1-time consultation services are for solo-practising PCPs and how best to support these and other PCPs in their management of patients with mental health needs.

Are Nurse-Led Patient Consultations and Nurse-Led Dose Adjustments of Permanent Medication Acceptable for Patients with Diabetes Mellitus and Hypertension in General Practice? - Results of a Focus Group Study.

Practice nurse (PN)-led patient consultations and PN-led dosage adjustments of permanent medication are uncommon and not well studied in general practice (GP) in Germany. We investigated the perspectives of patients with common chronic diseases in Germany, diabetes mellitus (DM) type 2 and/or arterial hypertension (AT), on PN-led patient consultations and dosage adjustments of permanent medications in GP. In this exploratory qualitative study, online focus groups were conducted using a semi-structured interview guide. Patients were recruited from collaborating GPs according to a predefined sampling plan. Patients were eligible for this study if they had DM or AT treated by their GP, were on at least one permanent medication and were aged 18 years or older. Focus group transcripts were analyzed using thematic analyses. Analyses of two focus groups, involving a total of 17 patients, revealed four main themes: (1) openness to the PN-led care and perceived benefits, eg because of patients' confidence in PNs' skills, or patients' impression that PN-led care would better meet their needs and increase their compliance. Some patients had (2) reservations and perceived risks, especially for PN-led medication changes eg feeling that medication adjustments were a GP's issue. Patients identified (3) reasons for encounters where they were likely to accept PN-led consultation and medication advice, eg management of DM, AT and thyroid disease. Patients also saw several important general requirements for the implementation of PN-led care in German general practice (4). There is a potential for openness towards PN-led consultation and PN-led medication adjustment for permanent medication in patients with DM or AT. This study is the first qualitative study to investigate PN-led consultations and medication advice in German general practice. If the implementation of PN-led care is planned, our findings add the patients' perspectives of acceptable reasons for encounter for PN-led care and their general requirements.

Clinician resistance to broaching the topic of weight in primary care: Digging deeper into weight management using strong structuration theory

Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of ‘caring by not offering care’ produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight.

Measurement of changes in uterine and fibroid volume during treatment of heavy menstrual bleeding (HMB).

Does application of an unbiased method for analysis of magnetic resonance (MR) images reveal any effect on uterine or fibroid volume from treatment of heavy menstrual bleeding (HMB) with three 12-week courses of the selective progesterone receptor modulator ulipristal acetate (SPRM-UPA)? Application of an unbiased method for analysis of MR images showed that treatment of HMB with SPRM-UPA was not associated with a significant reduction in the volume of the uterus or in the volume of uterine fibroids. SPRM-UPA shows therapeutic efficacy for treating HMB. However, the mechanism of action (MoA) is not well understood and there have been mixed reports, using potentially biased methodology, regarding whether SPRM-UPA has an effect on the volume of the uterus and fibroids. In a prospective clinical study (with no comparator), 19 women with HMB were treated over a period of 12 months with SPRM-UPA and uterine and fibroid size were assessed with high resolution structural MRI and stereology. A cohort of 19 women aged 38-52years (8 with and 11 without fibroids) were treated with three 12-week courses of 5 mg SPRM-UPA given daily, with four weeks off medication in-between treatment courses. Unbiased estimates of the volume of uterus and total volume of fibroids were obtained at baseline, and after 6 and 12 months of treatment, by using the Cavalieri method of modern design-based stereology in combination with magnetic resonance imaging (MRI). Bland-Altman plots showed good intra-rater repeatability and good inter-rater reproducibility for measurement of the volume of both fibroids and the uterus. For the total patient cohort, two-way ANOVA did not show a significant reduction in the volume of the uterus after two or three treatment courses of SPRM-UPA (P = 0.51), which was also the case when the groups of women with and without fibroids were considered separately (P = 0.63). One-way ANOVA did not show a significant reduction in total fibroid volume in the eight patients with fibroids (P = 0.17). The study has been performed in a relatively small cohort of women and simulations that have subsequently been performed using the acquired data have shown that for three time points and a group size of up to 50, with alpha (Type I Error) and beta (Type II Error) set to 95% significance and 80% power, respectively, at least 35 patients would need to be recruited in order for the null hypothesis (that there is no significant reduction in total fibroid volume) to be potentially rejected. The imaging protocol that we have developed represents a generic paradigm for measuring the volume of the uterus and uterine fibroids that can be readily incorporated in future studies of medical treatments of HMB. In the present study, SPRM-UPA failed to produce a significant reduction in the volume of the uterus or the total volume of fibroids (which were present in approximately half of the patients) after either two or three 12-week courses of treatment. This finding represents a new insight in respect of the management of HMB using treatment strategies that target hormone-dependence. The UPA Versus Conventional Management of HMB (UCON) trial was funded by the EME Programme (Medical Research Council (MRC) and National Institutes of Health Research (NIHR)) (12/206/52). The views expressed in this publication are those of the authors and not necessarily those of the Medical Research Council, National Institute for Health Research, or Department of Health and Social Care.Medical Research Council (MRC) Centre grants to the Centre for Reproductive Health (CRH) (G1002033 and MR/N022556/1) are also gratefully acknowledged. H.C. has clinical research support for laboratory consumables and staff from Bayer AG and provides consultancy advice (All paid to Institution) for Bayer AG, PregLem SA, Gedeon Richter, Vifor Pharma UK Ltd, AbbVie Inc., and Myovant Sciences GmbH. H.C. has received royalties from UpToDate for an article on abnormal uterine bleeding. L.W. has received grant funding from Roche Diagnostics (Paid to Institution). All other authors have no conflicts to declare. The study reported here is an embedded mechanism of action study (no comparator) within the UCON clinical trial (registration ISRCTN: 20426843).

Effect of participation of typical clinical pharmacists in patient medication in ICUs with different approaches: An investigation and case analysis

PurposeTo investigate and study the impact on patient recovery of pharmacists’ participation in the medication guidance and intervention of patients in intensive care units (ICUs). Patients and methodsWe analyzed the drug use and typical cases of patients in the ICU of our hospital during clinical pharmacists' consultations or active monitoring from July 2019 to December 2020. This study included a total of 292 cases, which were distributed in the following eight areas: drug adjustment based on patients with hepatic and renal insufficiency,optimisation of treatment regimens based on drug interaction, identification and intervention based on adverse drug reactions, selection of blood purification methods based on drug intoxication, infusion access adjustment based on drug compatibility, drug adjustment based on genetic testing, antibiotic dose adjustment based on pharmacokinetics/pharmacodynamics (PK/PD) and others. The main observation indexes included consultation opinion efficiency rates and acceptance rates. The acceptance rate is calculated according to the acceptance of the clinical pharmacist's opinion by the competent doctor (fully accepted, partially accepted, not accepted). Calculate the efficiency rate according to the effect of the intervention measures. Definition of effectiveness: improvement of therapeutic effect of drugs; Avoid the occurrence of potential adverse drug reactions; Avoid the occurrence of potential drug compatibility reaction (for example, adjust the infusion sequence to avoid turbidity and sedimentation in the infusion pathway). ResultsThe results showed that clinical pharmacists participated in 292 cases of consultation or active monitoring of patients in the hospital's ICU based mainly on specific patient medications, drug interactions, adverse drug reactions, blood purification therapy, drug compatibility/venous infusion pathways, blood drug concentrations/drug–gene monitoring, drug PK/PD, etc. The doctor in charge acceptance rate of the consultation advice was 88.46% (completely accepted by 59.3%, partially accepted by 30.8%), and the effective rate of the consultation was 80.2%. ConclusionBased on different purposes of intervention, the acceptance rate and efficiency rate were different. The efficiency rate with complete acceptance was significantly higher than that with partial acceptance or non-acceptance. The intervention opinions proposed by a comprehensive team in which pharmacists participate are of great help to patients and can reduce adverse reactions and medication risks. The higher the acceptance rate of their opinions, the higher the effective rate.

Barriers to and Facilitators of the Use of Digital Tools in Primary Care to Deliver Physical Activity Advice: Semistructured Interviews and Thematic Analysis.

BackgroundPhysical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes, and cancer; therefore, increasing physical activity (PA) is a public health priority. Health care professionals (HCPs) in primary care are pivotal in addressing physical inactivity; however, few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including lack of time, confidence, or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital tools are used to deliver PA advice in primary care consultations and what factors influence their use.ObjectiveWe aimed to understand the use of digital tools to support primary care consultations and to identify the barriers to and facilitators of using these systems.MethodsOverall, 25 semistructured interviews were conducted with primary care HCPs. Professionals were sampled based on profession (general practitioners, practice nurses, and health care assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. The data were analyzed thematically to identify the influences on the use of digital tools. Themes were categorized using the COM-B (capability, opportunity, and motivation—behavior) model and the Theoretical Domains Framework to identify the barriers to and facilitators of using digital tools to support the delivery of PA advice in primary care consultations.ResultsThe identified themes fell within 8 domains of the Theoretical Domains Framework. The most prominent influence (barrier or facilitator) within psychological capability was having the skills to use digital tools. Training in the use of digital tools was also mentioned several times. The most notable influences within physical opportunity were limited digital tools to prompt/support the provision of PA advice, time constraints, efficiency of digital tools, simplicity and ease of use of digital tools, and integration with existing systems. Other physical opportunity influences included lack of access to digital tools and technical support in the use of digital tools. Within social opportunity, a notable barrier was that digital tools reduce interpersonal communication with patients. Patient preference was also identified. Several important influences were within reflective motivation, including confidence to use digital tools, beliefs about the usefulness of digital tools, the belief that digital tools “are the way forward,” beliefs related to data privacy and security concerns, and perceptions about patient capabilities. About automatic motivation, influences included familiarity and availability regarding digital tools and the fact that digital tools prompt behavior.ConclusionsA variety of influences were identified on the use of digital tools to support primary care consultations. These findings provide a foundation for designing a digital tool addressing barriers and leverages the facilitators to support PA advice provision within primary care to elicit patient behavior change and increase PA.

Concurrent 9. Presentation for: The Queensland Resources Industry Development Plan: a 30-year plan to build a resilient, responsible and sustainable resources industry that grows as it transforms

Presented on Wednesday 18 May: Session 9 The Queensland resources industry will be increasingly affected by global trends, such as decarbonisation, corporate social responsibility, emerging innovations and the rise of the Indo-Pacific region. While these trends create challenges for the resources industry, they present greater opportunities for transformation, growth and diversification. A plan to navigate these trends is critical, and that is why the Queensland Government has committed to delivering a Queensland Resources Industry Development Plan (QRIDP). The QRIDP outlines a 30-year vision for Queensland’s resources industry – petroleum and gas, coal and minerals sectors – to respond to these emerging global trends. The QRIDP’s vision is for ‘a resilient, responsible and sustainable Queensland resources industry that grows as it transforms.’ A range of actions for government and industry to undertake over the coming years to realise this shared vision is included in the QRIDP in its six key focus areas. The QRIDP has been informed through extensive stakeholder consultation and expert advice, with a draft QRIDP released for feedback in November 2021. Feedback received on the draft is being considered by the Department of Resources and a final QRIDP is expected to be released by mid-2022. To access the presentation click the link on the right. To read the full paper click here

The Queensland Resources Industry Development Plan: a 30-year plan to build a resilient, responsible and sustainable resources industry that grows as it transforms

The Queensland resources industry will be increasingly affected by global trends, such as decarbonisation, corporate social responsibility, emerging innovations and the rise of the Indo-Pacific region. While these trends create challenges for the resources industry, they present greater opportunities for transformation, growth and diversification. A plan to navigate these trends is critical, and that is why the Queensland Government has committed to delivering a Queensland Resources Industry Development Plan (QRIDP). The QRIDP outlines a 30-year vision for Queensland’s resources industry – petroleum and gas, coal and minerals sectors – to respond to these emerging global trends. The QRIDP’s vision is for ‘a resilient, responsible and sustainable Queensland resources industry that grows as it transforms.’ A range of actions for government and industry to undertake over the coming years to realise this shared vision is included in the QRIDP in its six key focus areas. The QRIDP has been informed through extensive stakeholder consultation and expert advice, with a draft QRIDP released for feedback in November 2021. Feedback received on the draft is being considered by the Department of Resources and a final QRIDP is expected to be released by mid-2022.

Advising and limiting medical treatment during phone consultation: a prospective multicentre study in HEMS settings

BackgroundWe investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT).MethodsA prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period.ResultsOf all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or ‘not eligible for intensive care’ (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician.ConclusionConsultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.

Telekonsultasi Dalam Rangka Pemutusan Rantai Penularan Covid-19 di Kota Bengkulu

Coronavirus Disease-19 (Covid-19) is a disease that has become a global epidemic. The World Health Organization (WHO) has declared Covid-19 a pandemic. Indonesia declared the status of the Covid-19 disease to be an Emergency Response. Supporting the social distancing, the right strategy is needed to continue implementing health services amid the Covid-19 pandemic. This activity aimed to provide knowledge related to Covid-19 to the community and health consultations and medical advice through applications (teleconsultation) to minimize patients queuing at Health Service Facilities directly. The activity partners were the Indonesian Medical Association (IDI) Bengkulu City Branch, Bengkulu City Health Office, and the Indonesian Red Crescent (BSMI) Bengkulu City Region. The method of this activity was to provide socialization, health consultation and medical advice through applications (teleconsultation) regarding the spread, transmission and prevention of Covid-19 from May 1 to August 31 2020. The number of participants was 41 people from Bengkulu City. The highest number of diseases consulted were acute respiratory infections (38.7%.) and Covid-19 independent protocol consultation (31.58%.) Teleconsultation can be continued and developed into a patentable application. Application development is indispensable in responding to the challenges of the health world in the digital era.

Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study

ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This...

Acoustics in the culture of context

Not being an acoustician, I have limited knowledge of such expertise. I trust advice of consultants in your science to inform consideration of acoustical issues. Having designed projects in 46 countries I understand context is often represented incompletely in serving community needs. I will present more thorough representations of contextual forces informing my design, infusing regional voices in built work. Cultural influencers optimize design of sedate individual Korean restaurant rooms in contrast to strategies deployed in American restaurants where noise is utilized to maximize sales. I would intend to provoke this discussion. Context is generally defined as the physical setting affecting of buildings. Historically, identifiable nationalities or tribes have evolved organically over time, producing significantly unique DNA of each. These differences are most apparent in crafting buildings and conceiving art, music, and cuisine where acoustic social protocols are voiced. NATURAL FORCES affecting human comfort GEOGRAPHIC FORCES influencing integration with nature HISTORIC FORCES defining legacy of place URBAN FORCES defining constraints and opportunities PHYSICAL FORCES influencing disposition of a program on a specific site HUMAN FORCES defining community MARKET FORCES creating possibility DIGITAL FORCES redefining engagement ENGINEERING FORCES affecting psychological balance

Adherence to suggestions after dermatology consultation in a tertiary hospital - a retrospective analysis.

Dermatology consultation is a valuable inpatient service in Australian hospitals. Adherence rates to consultative advice in international literature range between 67.4% and 93%. This study identifies that adherence rates to suggested investigations and management in a tertiary Australian hospital are at the lower end of the range reported in previous literature.

Einstellung von Patienten zu möglicher Telemedizin in der Ophthalmologie

HintergrundDie COVID-19-Pandemie im Jahr 2020 und 2021 schränkt die Versorgung augenärztlicher Patienten vielfach ein. Teleophthalmologische Leistungen wie Videokonsultation oder medizinische Telefonberatungen könnten den Mangel an notwendigen Kontrollen bei chronischen Erkrankungen, zumindest teilweise, kompensieren. Teleophthalmologische Angebote sind jedoch in Deutschland aktuell noch deutlich unterrepräsentiert.Ziel der ArbeitUm die Bereitschaft auf Patientenseite zur Telemedizin und virtuellen Klinik zu ermitteln, führten wir bei Patienten der Hochschulmedizin mit bekanntem Glaukom als chronische Erkrankung eine Umfrage mittels Fragebogen während der ersten Welle der COVID-19-Pandemie zum Thema Teleophthalmologie durch.MethodenEs wurden 100 Patienten befragt. Der Fragenkatalog beinhaltete 22 Fragen mit Mehrfachwahl-Antwortmöglichkeiten. Als Einschlusskriterium galten das Vorhandensein eines Glaukoms als chronische Erkrankung, Alter über 18 Jahre sowie eine ausreichende sprachliche Verständigung zur Beantwortung der Fragen. Die Daten wurden anonymisiert erhoben, analysiert und ausgewertet.ErgebnisseIn der Patientenumfrage konnte aufgezeigt werden, dass eine hohe Bereitschaft zur Teleophthalmologie bei den Befragten im Bereich des Glaukoms als chronische Erkrankung vorhanden ist und diese in Anspruch genommen werden würde; 74,0 % der Befragten würden Telemedizin und virtuelle Kliniken akzeptieren; 54,0 % der Befragten ophthalmologischen Patienten gab an, dass ihr Arzt‑/Klinikbesuch aufgrund von SARS-CoV‑2 nicht stattfinden konnte; 17,0 % der Patienten gaben an, dass sich durch die SARS-CoV-2-Pandemie ihre Meinung gegenüber der Telemedizin geändert hat.DiskussionDie Akzeptanz der Patienten für Telemedizin bei Patienten mit chronischem Offenwinkelglaukom scheint erstaunlich hoch. Diese ist durch die SARS-CoV-2-Pandemie noch weiter gesteigert worden. Diese Ergebnisse spiegeln eine generelle Bereitschaft bei Patienten mit chronischer Augenerkrankung wider, reflektieren jedoch nicht die Anwendbarkeit sowie die Akzeptanz aus ärztlicher Sicht. Diese Form der virtuellen Konsultation findet jedoch bei einem Großteil der Patienten mit Glaukom Akzeptanz und könnte überdacht werden.

Effects of technology-enabled blood pressure monitoring in primary care: A quasi-experimental trial

Introduction Technology to enhance hypertension management is increasingly used in primary care; however, it has not been evaluated in an Asian primary care setting. We aimed to understand the clinical impact and cost-effectiveness of a technology-enabled home blood pressure monitor when deployed in primary care, and patients’ perspectives about the technology. Methods A quasi-experimental cohort study was conducted in a polyclinic in Singapore. In total, 120 patients with hypertension were assigned to the telemonitoring intervention group. Patients received a home blood pressure device connected to the clinical care team's dashboard through a mobile gateway. Tele-consultations and nurse-led tele-support were carried out using established clinical protocols. In total, 120 patients assigned to the control group continued to receive usual care in the polyclinic. Clinical outcomes, cost-effectiveness, and patient satisfaction were measured 6 months after recruitment. Results In total, 217 patients completed 6 months of follow-up. Telemonitoring intervention patients had significantly increased odds of having controlled blood pressure by a factor of 2.69 (p = 0.01), with the greatest improvement in those whose blood pressure was uncontrolled at baseline (p < 0.05). The incremental cost-effectiveness ratios for all patients was S$23,935.14/quality-adjusted life year (<1 gross domestic product per capita), which was very cost-effective based on World Health Organization cost-effectiveness thresholds. There was greater satisfaction in telemonitoring intervention group relating to the convenience of recording and sharing blood pressure measurements with the health care team, consultation advice received, understanding by the health care team of their condition, and were more motivated to monitor their blood pressure. Discussion Telemonitoring with tele-consultation improved blood pressure control and was more cost-effective than usual care. Patients receiving telemonitoring intervention were also more motivated and satisfied with their care.

Factors affecting the documentation of spoken safety-netting advice in routine GP consultations: a cross-sectional study.

BackgroundPrevious studies have reported how often safety-netting is documented in medical records, but it is not known how this compares with what is verbalised and what factors might influence the consistency of documentation.AimTo compare spoken and documented safety-netting advice and to explore factors associated with documentation.Design and settingA cross-sectional study, using an existing GP consultations archive.MethodObservational coding involving classifying and quantifying medical record entries and comparison with spoken safety-netting advice in 295 video-/audio-recorded consultations. Associations were tested using logistic regression.ResultsTwo-thirds of consultations (192/295) contained spoken safety-netting advice that applied to less than half of the problems assessed (242/516). Only one-third of consultations (94/295) had documented safety-netting advice, which covered 20.3% of problems (105/516). The practice of GPs varied widely, from those that did not document their safety-netting advice to those that nearly always did so (86.7%). GPs were more likely to document their safety-netting advice for new problems (P = 0.030), when only a single problem was discussed in a consultation (P = 0.040), and when they gave specific rather than generic safety-netting advice (P = 0.007). In consultations where multiple problems were assessed (n = 139), the frequency of spoken and documented safety-netting advice decreased the later a problem was assessed.ConclusionGPs frequently do not document the safety-netting advice they have given to patients, which may have medicolegal implications in the event of an untoward incident. GPs should consider how safely they can assess and document more than one problem in a single consultation and this risk should be shared with patients to help manage expectations.