Inadequate Consultation Research Articles

'He said he had been out doing the traffic': general practitioner perceptions of sexually transmitted infection and HIV testing strategies for men

Sexual health is an important component of primary care, and optimal sexually transmitted infection (STI) and HIV testing by doctors could help improve sexual health outcomes for men. Currently, little is known about general practitioners' (GPs') assessment of STI and HIV risk, particularly in relation to male patients, and the degree to which current advice can be translated into consistent testing protocols. The aim of the study was to explore STI and HIV testing strategies for men in general practice and opportunities and barriers to more optimal testing. This study used a qualitative, multiple-case methodology, incorporating 17 distinct GP cases, drawing on in-depth, semi-structured interviews, and using thematic analysis. The following themes were identified: sexual health consultations by men in general practice are usually initiated by the patient; GPs appear to have a consistent rationale for their risk assessments in terms of STI testing; the nature of the doctor's interaction with men influences the quality of sexual health services utilisation; optimal sexual health consultations require sufficient time and a recognition of the 'delicacy' of the consultation content for both patient and health practitioner. The stratified testing strategies undertaken by GPs appeared appropriate given the risk profiles of their patients. Constraints to optimal sexual health consultations were identified, including inadequate consultation time, male utilisation of GP consultations, and challenges in discussing sexual health topics within the consultation. Prioritising men's sexual health as a topic in CME may be helpful.

Aboriginal health research in the remote Kimberley: an exploration of perceptions, attitudes and concerns of stakeholders.

BackgroundFor decades Indigenous peoples have argued for health research reform claiming methods used and results obtained often reflect the exploitative history of colonisation. In 2006 the Kimberley Aboriginal Health Planning Forum (KAHPF) Research Subcommittee (hereafter, the Subcommittee) was formed to improve research processes in the remote Kimberley region of north Western Australia. This paper explores the major perceptions, attitudes and concerns of stakeholders in the Subcommittee.MethodsQualitative analysis was carried out on data retrospectively collected from multiple evidentiary sources linked to the Subcommittee i.e. database, documents, interviews, review forms and emails from 1 January 2007 to 31 October 2013.ResultsFrom 1 January 2007 to 30 June 2013 the Subcommittee received 95 proposals, 57 (60%) driven by researchers based outside the region. Local stakeholders (22 from 12 different Kimberley organisations) raised concerns about 36 (38%) projects, 30 (83%) of which were driven by external researchers. Major concerns of local stakeholders were inadequate community consultation and engagement; burden of research on the region; negative impact of research practices; lack of demonstrable community benefit; and power and control of research. Major themes identified by external stakeholders (25 external researchers who completed the review form) were unanticipated difficulties with consultation processes; barriers to travel; perceiving research as a competing priority for health services and time-consuming ethics processes. External stakeholders also identified strategies for improving research practices in the Kimberley: importance of community support in building good relationships; employing local people; flexibility in research approaches; and importance of allocating sufficient time for consultation and data collection.ConclusionsHealth research in the Kimberley has improved in recent years, however significant problems remain. Prioritising research addressing genuine local needs is essential in closing the gap in Indigenous life expectancy. The long-term aim is for local health service connected researchers to identify priorities, lead, conduct and participate in the majority of local health research. For this to occur, a more radical move involving reconceptualising the research process is needed. Changes to institutional timeframes and funding processes could improve Indigenous and community-based research.

‘Thinking makes it so’: reflections on the ethics of displaying Egyptian mummies

Controversy about museums’ possession and exhibition of human remains has usually affected those identified as ancestral remains by indigenous peoples. Egyptian mummies, with their long tradition of exhibition, seemed exempt from such considerations until the covering of unwrapped remains in the Egyptian gallery at The Manchester Museum in 2008. The museum’s representatives argued that this covering responded to visitors’ objections, but sub sequent widespread protest against the measure suggested that it had been carried out with inadequate public consultation. With reference to the Manchester case, I will present two arguments to expand the scope of current debates about human remains display. The first argument favours the consideration of museum visitors from cultures other than those represented by exhibited remains as legitimate stakeholders in the remains’ management, including consideration of their personal reasons and historical precedents for favouring display. The second argument, which reveals the spurious bases of many objections to Egyptian mummies’ display and demonstrates their derivation from misconceptions promulgated by the media, shows that the grounds for public objections to human remains display should be more critically examined. If perpetuated rather than halted, the display of mummies could be used to actively combat disparaging media stereotypes. Human remains exhibition is not inherently offensive, but can be regarded as such by visitors whose cultural backgrounds fail to prepare them for encounters with the dead. Removing the dead from display avoids engagement with ethics debates rather than facing the challenge of finding ways to respect the dead by facilitating encounters with them.

Popularization of Print Media through “Village Library” at Village Level: An Efficient Tool to Enhance the Productivity

Agricultural technology is moving so quickly, and in so many directions, that it has become challenging to even pay attention—we are victims of “next new thing” fatigue. The parade of new technologies and scientific breakthroughs is relentless and is unfolding on many fronts. Almost any advance is advocated as a breakthrough, and the list of “next big thing” goes on adding one after the other. Yet some technologies do in fact have the potential to disrupt the status quo, alter the way people live and work, rearrange value pools and lead to entirely new products and services. Public agricultural extension systems often fail due to inadequate consultation of farmers about their information needs and poor understanding of their information search strategies. The present study intends to identify various agricultural magazines as sources for technology access through village library to farmers, with the socio-economic characteristics. A proportionate sample of 120 respondents was selected at random and the data were collected with the help of a pre-tested and validated questionnaire and were analyzed by using computer software Statistical Package for Social Sciences (SPSS). The results reveal that more than 65 per cent farmers who were youth had a quest for new technological interventions, local language was preferred more owing to low qualification levels.

First do no harm: pressing concerns regarding euthanasia in Belgium

This article is concerned with the practice of euthanasia in Belgium. Background information is provided; then major developments that have taken place since the enactment of the Belgian Act on Euthanasia are analysed. Concerns are raised about (1) the changing role of physicians and imposition on nurses to perform euthanasia; (2) the physicians' confusion and lack of understanding of the Act on Euthanasia; (3) inadequate consultation with an independent expert; (4) lack of notification of euthanasia cases, and (5) organ transplantations of euthanized patients. Some suggestions designed to improve the situation and prevent abuse are offered.

Blurred Vision: The Calgary Union Stockyard Issue, 1913–1914

Calgary's historic association with the ranching industry and the increased volume of livestock from mixed farms led municipal leaders to explore the possibility of establishing a union stockyard in the city in 1913–1914. The measures taken to realize this ambition proved futile for several reasons. City leaders could not match their vision with coherence or direction. The result was inadequate consultation with stakeholders, internecine rivalries, and an almost comical sequence of policy changes in which the city's role in the proposed stockyards stance went from coordinator to partner to sole owner. City Council's well-meaning but ill-informed campaign reflected the random approach to civic policy-making that characterized municipal governments of the period.

Community perspectives of natural resource extraction: coal-seam gas mining and social identity in Eastern Australia

Using a recent case study of community reaction to proposed coal-seam gas mining in eastern Australia, we illustrate the role of community views in issues of natural resource use. Drawing on interviews, observations and workshops, the paper explores the anti-coal-seam gas social movement from its stages of infancy through to being a national debate linking community groups across and beyond Australia. Primary community concerns of inadequate community consultation translate into fears regarding potential impacts on farmland and cumulative impacts on aquifers and future water supply, and questions regarding economic, social and environmental benefits. Many of the community activists had not previously been involved in such social action. A recurring message from affected communities is concern around perceived insufficient research and legislation for such rapid industrial expansion. A common citizen demand is the cessation of the industry until there is better understanding of underground water system interconnectivity and the methane extraction and processing life cycle. Improved scientific knowledge of the industry and its potential impacts will, in the popular view, enable better comparison of power generation efficiency with coal and renewable energy sources and better comprehension of the industry as a transition energy industry. It will also enable elected representatives and policy makers to make more informed decisions while developing appropriate legislation to ensure a sustainable future.

Knowledge, attitude and practice of physiotherapists towards promotion of physically active lifestyles in patient management

BackgroundPhysiotherapists as primary health care practitioners are well placed in promoting physically active lifestyles, but their role and practice towards its promotion among patients in Nigeria has not been fully investigated. This study was therefore aimed at determining the knowledge, attitude and practice of Nigerian physiotherapists towards promotion of non-treatment physical activity among patients.MethodsThree hundred and eight practicing physiotherapists from various public and private hospitals in 14 states of Nigeria completed an adopted 20-item questionnaire, which collected information on physical activity promotion in physiotherapy practice.ResultRespondents with good knowledge and attitude towards physical activity promotion in patient management were 196(63.6%) and 292(94.8%) respectively. Only 111 (36%) of the respondents counselled more than 10 patients in the past one month on the benefits of adopting a more physically active lifestyle. Chi-square analysis showed a significant association between low practice of physical activity promotion in patient management with inadequate consultation time (ℵ2 = 3.36, p = 0.043), years of working experience of physiotherapists (ℵ2 = 11.37, p =0.023) and relative physical activity levels of physiotherapists (ℵ2 = 11.82, p = 0.037). The need for Physical activity recommendation guideline was supported by 287 (97%) respondents.ConclusionNigerian physiotherapists have good knowledge and attitude towards promotion of physically active lifestyle in their patients but do not counsel many of them, due to insufficient consultation time. Integrating brief counselling into usual treatment sessions is perceived as the most feasible form of physical activity promotion in patient management.

Procedural Justice in Carbon Capture and Storage

This paper examines where and how claims of procedural injustice, or demands for procedural justice, might arise with respect to carbon capture and storage (CCS), taking a broad view of the CCS research, development and deployment process. It considers the principles that might govern such claims and seeks to identify where responsibility might lie for ensuring justice, or addressing contested claims of injustice. It is suggested that claims of procedural injustice arising from CCS are most likely to arise during implementation, from locally affected populations, raising concerns of inadequate information or consultation; but they may also arise from representatives of other indirectly affected groups, such as those affected by upstream impacts of coal mining, or energy market consequences of CCS policy. It is further suggested that claims are most likely to be directed at public authorities in respect of decisions over policy, strategy or authorisations for individual developments, but there are also routes by which claims may be directed at the corporations involved, especially under human rights provisions. The paper suggests a need for careful consideration of both procedural and, by implication, distributive justice matters in the emerging regulatory and support framework for CCS, with a particular imperative for moving public engagement upstream prior to deployment and indeed even to research programmes, to maximise the scope for legitimate influence on future outcomes.

Popular but Unstable: Explaining Why State Performance Funding Systems in the United States Often Do Not Persist

Background/ContextPerformance funding in higher education ties government funding to institutional performance on indicators such as retention, graduation, and job placement. Performance funding can also be found in state K-12 funding policies and higher education quality assurance programs abroad. One of the puzzles about higher education performance funding is that half of the states establishing it later abandoned it.Purpose/Objective/Research Question/Focus of StudyThis study examines the factors that have led many states to drop performance funding for higher education.Research DesignThis qualitative case study contrasts the experiences of three states that dropped performance funding in whole or in part (Missouri, Washington, and Florida) and a fourth (Tennessee) that has retained it more than 30 years.DiscussionOur analysis is based on documentary records and extensive interviews with higher education officials, legislators and staff, governors and advisors, business leaders, minority group leaders, researchers, and outside consultants. Our findings concur with but also go beyond prior analyses of the demise of state performance funding systems. We concur that higher education opposition played a key role in this demise, stimulated by a perception of inadequate consultation with higher education institutions, use of performance indicators that institutions found invalid, high implementation costs to institutions, and erosion of campus autonomy. At the same time, our analysis turned up other causes of higher education opposition to performance funding that were not discovered by previous studies. A major cause of higher education opposition was the downturn in state finances in the early 2000s, which led institutions to focus on preserving their core state funding and giving up performance funding. Higher education opposition was also provoked if performance funding took the form not of adding to existing state funding but instead holding back a portion of the state appropriation and requiring institutions to earn it back through improved performance. These findings agree and disagree with theories and findings in the research literatures on policy termination and program sustainability.Conclusions/RecommendationsIf its advocates are to create a sustainable basis for state performance funding, they must find ways to insulate its funding from the ups and downs of the state revenue cycle, better secure the support of public institutions, and expand its breadth of political support by reaching out, for example, to business and to social groups driven primarily by the values of educational equality rather than educational efficiency.

Evaluation of the Environmental Impacts Assessment (EIA) System in Lao PDR

This study explores and seeks to explain the EIA procedures practice gap in Lao PDR. It reviews the literature and studies EIA legislation, administrative procedures, guidelines, and relevant documents by using a model proposed by Leu et al. (1996) and applying criteria proposed by Wood (1995) to evaluate the performance of EIA systems. Key EIA legislation in Lao PDR has many strengths, but also major weaknesses: Inadequate planning procedures, no secondary regulations, few trained and skilled personnel, inadequate public consultation, lack of environmental data, weak follow-up and monitoring, and no enforcement machinery. Additionally, the EIA approval procedure is very bureaucratic and easily derailed by political and economic pressures. In addition, coordination among EIA proponents, consultants, concerned ministries, local authorities, planners, and decision-makers is generally weak. This delays decision-making and hinders implementation of environmental regulations. Thus, procedures and evaluation are not always performed well. EIAs are more a project justification tool than a project planning tool for sustainable development. We conclude with recommendations to strengthen the system, such as improving capacity building, implementing an EIA consultants’ accreditation system, ensuring effective public participation and access to EIA reports, applying systematic EIAs, reviewing criteria, and promoting environmental awareness.

A qualitative evaluation of a regional Early Psychosis Service 3 years after its commencement

To outline the major findings of a qualitative evaluation of an Early Psychosis Service 3 years after its establishment. Data to evaluate the service were collected from team meetings, focus groups, individual interviews and questionnaires administered to clinicians, school staff, patients, carers and families. Barwon Health; Mental Health, Drug and Alcohol Services provide public mental health care to the Geelong, Victoria, region (population 270 000), which is a mixed urban and rural setting. The Early Psychosis Service model implemented involved the placement of two early psychosis workers into each of five adult geographically based Area Mental Health Teams rather than the establishment of a single Early Psychosis Team. The service was found not to adhere to its original design in several key respects. Caseloads and periods of case management were found to be lower and shorter respectively than was originally planned for, caseworkers often experienced isolation and resentment from their adult service coworkers, the service was perceived to be difficult to access and premises not to be youth friendly and communication and engagement with external agencies and service providers was perceived to be poor. The choice of service model, inadequate consultation with stakeholders and inadequate promotion of the service contributed to its failure to reach early expectations. Because of these and other issues, including difficulties distinguishing between early psychosis and non-psychosis, a decision was made to restructure youth services and a separate youth mental health service, which incorporated the Early Psychosis Service function, was established.

Flexible Design of Public Housing in Iqaluit, Nunavut, Canada

Public housing delivered in the Canadian Arctic has been ill-adapted to the social and cultural realities of Inuit communities and to northern climate. Inadequate consultation has resulted in dwellings that fails to adapt to the needs of growing families, impedes the ability of residents to engage in land-based activities, and is inappropriate for local climate. This paper examines how a user-led, flexible approach can help tailor the design of new public homes to the needs of the local housing authority and future occupants. Flexibility is incorporated into the pre-occupancy, post-occupancy and refurbishment stages of the units life-cycle, ensuring that they can be easily adapted over time. A menu of interior and exterior design components has been developed for selection by all stakeholders. The redevelopment of Widow's Row, in Iqaluit, Nunavut demonstrates how appropriate design can play a pivotal role in addressing the housing crisis.

Evaluation of the environmental impact assessment system in Egypt

A formal environmental impact assessment (EIA) system was introduced in Egypt through Environmental Protection Law No. 4 of 1994. This paper evaluates the EIA system in Egypt by using both ‘systemic’ and ‘foundation’ evaluation criteria. The methodology is based on an investigation of EIA legislation, a review of guidelines and relevant documents, and interviews with EIA practitioners. The main factors affecting EIA best practice in Egypt are the limited numbers of local experts, inadequate public consultation, lack of environmental data, weak follow-up, and the absence of long- term land-use plans. Recommendations to strengthen the system include improving capacity building, implementing an effective EIA consultants' accreditation system, ensuring effective public participation and access to EIA reports, applying systematic environmental impact statement (EIS) review criteria and promoting environmental awareness.

Inadequate consultation behavior modulates the relationship between Type D personality and impaired health status in chronic heart failure

Background Psychological risk factors for impaired health outcomes have been acknowledged in chronic heart failure (CHF), with Type D personality being such a risk factor. Inadequate consultation behavior, a specific aspect of self-management, might be one mechanism in explaining the adverse effect of Type D on health outcomes. In this study we examined the relationship between Type D personality, impaired disease-specific health status, and inadequate consultation behavior. Methods and results CHF outpatients ( n = 313) completed the Type D Scale (DS14) at baseline, and the European Heart Failure Self-care Behaviour Scale (EHFScBS) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) at 6-month follow-up. Type D personality independently predicted inadequate consultation behavior (OR = 1.80, 95%CI [1.03–3.16], p = .04) and impaired health status (OR = 3.61, 95%CI [1.93–6.74], p < .001) at 6-month follow-up, adjusting for demographic and clinical variables. Inadequate consultation behavior (OR = 1.80, 95%CI [1.11–2.94], p = .02) and NYHA-class (OR = 2.83, 95%CI [1.17–4.71], p < .001) were associated with impaired health status, after controlling for demographics, clinical variables, and Type D personality. Post-hoc multivariable analysis pointed out that Type D patients who displayed inadequate consultation behavior were at a 6-fold increased risk of reporting impaired health status, compared to the reference group of non-Type D patients who displayed adequate consultation behavior (OR = 6.06, 95%CI [2.53–14.52], p < .001). Conclusions These findings provide evidence for inadequate behavior as a mechanism that may explain the link between Type D personality and impaired health status. Future studies are warranted to elaborate on these findings.

Perception of consultation length in cardiology and its ethical implications

This study considered whether the time employers allotted to medical consultations in many working environments in Argentina might be inadequate to carry out an interview. The objective was to conduct a survey to gather information on the length of cardiologic medical consultations in Argentina. During 2007, a survey was carried out that included 816 cardiologists. Seventy-six percent of participants said they needed 20 to 30 minutes, and 14% considered that 15 minutes was sufficient, for an adequate consultation. On the other hand, 64% reported that their employer required that consultations be done in 10 to 15 minutes, and 86% cited limits of less than 20 minutes (P < 0.0001). This time was inadequate for 60% of physicians. With regard to ethics, 89% answered affirmatively that requiring that patients be attended in such a short time could be considered an ethical flaw of the employer; 75% acknowledged their own ethical flaw when agreeing to conduct the consultation in an inadequate amount of time. When opinions were grouped, 22% considered that an adequate consultation length was fundamental for a correct patient-physician relationship, 27% reported that this time depended on "pressures" of the system, 19% indicated that inadequate consultation length affected the quality of attention patients received, 17% thought that low fees forced employers to reduce this time with a resulting detriment in quality of care, and 15% said that consultation length was variable and depended on the patient. This study showed that 60% of physicians perceived as insufficient the time their employers allotted for conducting an adequate consultation. Most believed that allotting such a short time for examining patients could be considered an ethical flaw.

Problems in diagnosing odontogenic myxoma: Case report

Tumours and tumour-like growths arising from odontogenic tissues constitute a heterogenous group of lesions whose diagnosis can be particularly challenging on the part of both surgeons and pathologists. In children, these lesions are even more difficult to clinically and histopathologically diagnose definitively because of the concurrent diverse embryologic differentiation of dental tissues. A case is presented of a 12 year-old boy who was subjected to inappropriate primary management of a left mandibular mass, due apparently to inadequate consultation to establish an accurate diagnosis.

Impacts of Colonial Law and Policy on Indigenous Family Life in Australia

From the moment that Britain colonised the landmass of Australia, the continuation of traditional Indigenous family life was threatened. It has even been argued that the policy and legislation of successive governments attempted to destroy the rights of Indigenous peoples to their children. Indigenous children were removed from their communities. These children are now known as the Stolen Generations. Past colonial law and policy continues to impact upon the enjoyment of traditional family life with disproportionately high removal rates of Indigenous children from their families and communities. Nationwide solutions such as the Aboriginal Child Placement Principle have gone some way in redressing this issue. In its present form, however, it remains a victim of poor implementation, funding, and inadequate consultation with Indigenous communities.

Development of a forest certification standard compatible with PEFC and FSC's management requirements. A case study from Greece

Summary Greece currently has no national forest certifi cation standard. This paper explains how a draft forest management standard for Greece was developed to be compatible with both the Forest Stewardship Council and the Programme for the Endorsement of Forest Certifi cation schemes requirements. The draft standard was tested in two contrasting forest areas to investigate its ease of operation, to indicate necessary refi nements to the standard and to reveal major areas of weakness in current forest management practices. Field testing showed that the standard was operationally effi cient and that relatively few changes to the standard were necessary. Major weaknesses in current management practices were identifi ed as breaches of health and safety, poor training of forest workers and inadequate consultation with stakeholders.

General practitioners' attitudes towards patients with disabilities: The need for training and support

Purpose. Some general practitioners (GPs) report discomfort in caring for people with disabilities. These feelings may impede the provision of quality health care to these patients.Method. A cross-sectional survey interviewed 600 GPs in southeastern France and assessed their personal and professional characteristics, their attitudes and opinions towards people with disabilities, and their knowledge and practices in this field.Results. 21.3% of the GP reported discomfort in treating people with mental impairments and 8.2% people with physical impairments. Discomfort with either type of impairment was more frequent among GPs who perceived frequent communication problems with persons with disabilities (p < 0.05) or who did not belong to a professional network (p < 0.10). GPs who reported less experience with the disabled patients (p < 0.05), no medical training about disabilities (p = 0.04), a lack of assistance during consultations (p = 0.02), and inadequate consultation time (p = 0.09) expressed more discomfort in caring for patients with mental impairments. GPs' discomfort was associated with their assessment of the patient's level of disability among patients with physical impairments (p = 0.01).Conclusion. This study suggests that substantial obstacles related to GPs' attitudes impede the delivery of quality health care to patients with disabilities and that GPs need more support and guidance in dealing with them. These results raise also the issue of adequate time and remuneration for consultations with these patients.