Practice Consultations Research Articles

Sistem Pakar Diagnosis Penyakit Rhinitis Menggunakan Metode Forward Chaining Berbasis Web

The development of technology and information systems that are growing rapidly as it is today, requires everyone to continue to develop knowledge so as not to be out of date. The use of technology today can be used in all fields, such as education, security, health, and so on. Expert systems in the health sector are designed and made to imitate an expert who can facilitate the work of an expert in making decisions to solve problems. In a case study conducted at the Dadi Family Hospital, Purwokerto, data were obtained from patients with a diagnosis of rhinitis, the majority of whom did not know information about the symptoms and diseases. Rhinitis is an inflammatory disease or inflammation of the nasal mucosa that is triggered by certain allergens. The increasing number of ENT diseases, especially rhinitis, is not accompanied by the number of experts. In this case, it is necessary to conduct an analysis to speed up the diagnosis process by medical personnel. Based on the case study, an information system is needed that can be used by its users as a source of information as well as a more practical consultation media. In designing this system using PHP and MySQL with research datasets obtained from hospital medical records. For the development of the system using the waterfall method with the forward chaining method as a method of searching or drawing conclusions based on existing data or facts leading to conclusions. Then in testing the system using the black box as a feature functionality test, as well as testing the System Usability Scale (SUS) as a system feasibility test, and testing the accuracy of the expert system using the confusion matrix. For the results of the accuracy of this expert system obtained by 93%

Undergraduate medical teaching with remote consultations in general practice: a realist evaluation.

Supervisors historically educated students in primary care in face-to-face contexts; as a result of COVID-19, students now experience patient consultations predominantly remotely. There is a paucity of evidence regarding the facilitators and barriers to supervising students for excellent educational impact in the remote consultation environment. To understand the facilitators and barriers to educating medical students using remote consultations in primary care, and the consequences for students in terms of educational impact. A realist evaluation methodology was adopted to identify causal chains of contexts, mechanisms, and outcomes, describing how the teaching and learning functioned on a sample of medical students and GP tutors from two medical schools in London, UK. An initial programme theory was developed from the literature and a scoping exercise informed the data collection tools. Qualitative data were collected through online questionnaires (49 students, 19 tutors) and/or a semi-structured interview (eight students, two tutors). The data were coded to generate context-mechanisms-outcome configurations outlining how the teaching and learning operated. The results demonstrated a sequential style of supervision can positively impact student engagement and confidence, and highlighted a need to address student preparation for remote patient examinations. Students found passive observation of remote patient encounters disengaging, and, in addition, reported isolation that impacted negatively on their experiences and perceptions of primary care. Student and tutor experiences may improve through considering the supervision style adopted by tutors, and through interventions to reduce student isolation and disengagement when using remote patient consultations in primary care.

Why do GPs rarely do video consultations? qualitative study in UK general practice.

Fewer than 1% of UK general practice consultations occur by video. To explain why video consultations are not more widely used in general practice. Analysis of a sub-sample of data from three mixed-method case studies of remote consultation services in various UK settings from 2019-2021. The dataset included interviews and focus groups with 121 participants from primary care (33 patients, 55 GPs, 11 other clinicians, nine managers, four support staff, four national policymakers, five technology industry). Data were transcribed, coded thematically, and then analysed using the Planning and Evaluating Remote Consultation Services (PERCS) framework. With few exceptions, video consultations were either never adopted or soon abandoned in general practice despite a strong policy push, short-term removal of regulatory and financial barriers, and advances in functionality, dependability, and usability of video technologies (though some products remained 'fiddly' and unreliable). The relative advantage of video was perceived as minimal for most of the caseload of general practice, since many presenting problems could be sorted adequately and safely by telephone and in-person assessment was considered necessary for the remainder. Some patients found video appointments convenient, appropriate, and reassuring but others found a therapeutic presence was only achieved in person. Video sometimes added value for out-of-hours and nursing home consultations and statutory functions (for example, death certification). Efforts to introduce video consultations in general practice should focus on situations where this modality has a clear relative advantage (for example, strong patient or clinician preference, remote localities, out-of-hours services, nursing homes).

General practice and associated health conditions in patients aged 65 years or over.

We aimed at identifying associations of health conditions addressed during general practice consultations involving patients aged 65 years or over, according to sex. This is an ancillary study of the ECOGEN study on the consultation practices of French general practitioners. We studied the 15 most frequent health issues addressed in patients aged 65 years or over and identified the pairs most frequently and strongly associated. The sample included 5,782 consultations corresponding to 17,182 health issues addressed. Each consultation involved an average of 3.0 [2.9-3.0] health issues. The strongest associations mainly included cardio-metabolic conditions. The most frequent and strong pair (OR: 3.8 [3.3-4.4]) associated non-complicated arterial hypertension with a lipid disorder. Some associations were specific to the patient's sex. Significant associations identified may improve the management of elderly patients with multiple morbidities by encouraging synergic treatments.

How do multi-morbidity and polypharmacy affect general practice attendance and referral rates? A retrospective analysis of consultations.

As prevalence of multimorbidity and polypharmacy rise, health care systems must respond to these challenges. Data is needed from general practice regarding the impact of age, number of chronic illnesses and medications on specific metrics of healthcare utilisation. This was a retrospective study of general practices in a university-affiliated education and research network, consisting of 72 practices. Records from a random sample of 100 patients aged 50 years and over who attended each participating practice in the previous two years were analysed. Through manual record searching, data were collected on patient demographics, number of chronic illnesses and medications, numbers of attendances to the general practitioner (GP), practice nurse, home visits and referrals to a hospital doctor. Attendance and referral rates were expressed per person-years for each demographic variable and the ratio of attendance to referral rate was also calculated. Of the 72 practices invited to participate, 68 (94%) accepted, providing complete data on a total of 6603 patients' records and 89,667 consultations with the GP or practice nurse; 50.1% of patients had been referred to hospital in the previous two years. The attendance rate to general practice was 4.94 per person per year and the referral rate to the hospital was 0.6 per person per year, giving a ratio of over eight attendances for every referral. Increasing age, number of chronic illnesses and number of medications were associated with increased attendance rates to the GP and practice nurse and home visits but did not significantly increase the ratio of attendance to referral rate. As age, morbidity and number of medications rise, so too do all types of consultations in general practice. However, the rate of referral remains relatively stable. General practice must be supported to provide person centred care to an ageing population with rising rates of multi-morbidity and polypharmacy.

Clustering of comorbidities and associated outcomes in people with osteoarthritis - A UK Clinical Practice Research Datalink study

To examine the clusters of chronic conditions present in people with osteoarthritis and the associated risk factors and health outcomes. Clinical Practice Research Datalink (CPRD) GOLD was used to identify people diagnosed with incident osteoarthritis (n=221,807) between 1997 and 2017 and age (±2 years), gender, and practice matched controls (no osteoarthritis, n=221,807) from UK primary care. Clustering of people was examined for 49 conditions using latent class analysis. The associations between cluster membership and covariates were quantified by odds ratios (OR) using multinomial logistic regression. General practice (GP) consultations, hospitalisations, and all-cause mortality rates were compared across the clusters identified at the time of first diagnosis of osteoarthritis (index date). In both groups, conditions largely grouped around five clusters: relatively healthy; cardiovascular (CV), musculoskeletal-mental health (MSK-MH), CV-musculoskeletal (CV-MSK) and metabolic (MB). In the osteoarthritis group, compared to the relatively healthy cluster, strong associations were seen for 1) age with all clusters; 2) women with the MB cluster (OR 5.55: 5.14-5.99); 3) obesity with the CV-MSK (OR 2.11: 2.03-2.20) and CV clusters (OR 2.03: 1.97-2.09). The CV-MSK cluster in the osteoarthritis group had the highest number of GP consultations and hospitalisations, and the mortality risk was 2.45 (2.33-2.58) times higher compared to the relatively healthy cluster. Of the five identified clusters, CV-MSK, CV, and MSK-MH are more common in OA and CV-MSK cluster had higher health utilisation. Further research is warranted to better understand the mechanistic pathways and clinical implications.

How complex are general practice consultations?

A recent study measured the complexity of GP face-to-face consultations with implications for funding and staffing. Dave Hancock considers the findings

An evaluation of the safety of telephone first consultations in physiotherapy MSK practice

An evaluation of the safety of telephone first consultations in physiotherapy MSK practice

In Focus: Industry responds to illegal practice consultation

Organisations from across the optical sector have responded to the GOC's revised illegal practice protocol. Yiannis Kotoulas consultation.

Bio-psycho-social characteristics and impact of musculoskeletal pain in one hundred children and adolescents consulting general practice

BackgroundEight percent of all child and adolescent general practice consultations are due to musculoskeletal conditions, with pain as the most frequent symptom. Despite the commonality of musculoskeletal pain, limited knowledge exists about care-seeking children and adolescents with musculoskeletal pain.The purpose of this study was to describe characteristics of children and adolescents consulting their general practitioner with musculoskeletal pain.MethodsThis is a cross-sectional study based on baseline data from the child and adolescent musculoskeletal pain cohort study (ChiBPS), carried out in 17 Danish general practice clinics. Patients aged 8–19 years who had musculoskeletal pain when consulting their general practitioner were recruited. Participants completed a questionnaire on demographics, physical activity, pain impact, psychosocial factors, and expectations of their general practitioner. Descriptive statistics were used to summarize data. Normally distributed continuous data were described using mean and standard deviation while non-normally data were described using median and interquartile range (IQR).ResultsWe included 100 participants (54% female, median age 13 [IQR: 12–16.5 years]). Frequent pain sites limiting activity were knee (56%), back (20%), ankle (19%), and neck (13%). Most participants (63%) consulted their general practitioner due to inability to use their body as usual, due to pain. Median pain duration at consultation was 5 months [IQR: 3 weeks-1 year]. More than a third were often/sometimes nervous (34%), worried or anxious (33%), and took pain medication (33%). Pain impeded ability to participate in sport activities at school (79%) and disturbed spare time activities (88%). Pain also made it difficult to concentrate for 58%, and to fall asleep for 38%. Only 38% expected a pain free long-term future.ConclusionThis study demonstrates the bio-psycho-social impact of musculoskeletal pain in care-seeking children and adolescents. Demographics, pain characteristics, psychosocial characteristics, and physical characteristics should be included in addressing children and adolescents with musculoskeletal pain.Trial registrationThe ChiBPS study was pre-registered before participant recruitment (ClinicalTrials.gov Identifier: NCT03678922) date: 09.20.18.

Use of online material in teaching general practice

In the general practice course at Copenhagen University, students record videos of their consultations in general practice. At university, the videos are discussed with a teacher and peers. Simulated video consultations were produced to support learning. The aim of this study was to evaluate the effect of adding simulated consultation videos to standard teaching.
 Final semester students (N=587) were assigned by the university to six groups and received more online teaching material one step at a time. A questionnaire and a test video consultation measured the change in students’ ability to identify patient-centered elements in a consultation pre-and post-course. Effect sizes were calculated as the difference between the pre-and post-course measures divided by the mean-variance before the course.
 The overall teaching effect size (ES) was positive (0,67). A high average ES of 0.94 was found for the communication questions, which included most of the patient-centered elements. Introducing simulated video consultations did not increase awareness of patient-centered elements. However, an increase in clinical skills was demonstrated.
 Showing simulated video consultations from general practice increase the students awareness of clinical cases in general practice and can be supplement to the clinical teaching.

Challenges in the Intraoperative Consultation of Low-Grade Epilepsy-Associated Neuroepithelial Tumors by Cytomorphology in Squash Preparations

Introduction: Low-grade epilepsy-associated neuroepithelial tumors (LEATs) create a diagnostic challenge in daily practice and intraoperative pathological consultation (IC) in particular. Squash smears are extremely useful in IC for accurate diagnosis; however, the knowledge on cytopathologic features of LEATs is based on individual case reports. Here, we discuss the 3 most common and well-established entities of LEATs: ganglioglioma (GG), dysembryoplastic neuroepithelial tumor (DNT), and papillary glioneuronal tumor (PGNT). Methods: Thirty patients who underwent surgery for GG, DNT, and PGNT between 2001 and 2021 were collected. Squash smears prepared during intraoperative consultation were reviewed by 1 cytopathologist and an experienced neuropathologist. Results: Among the 30 tumors, 16 (53.3%) were GG, 11 (36.6%) DNT, and 3 (10%) PGNT. Cytomorphologically, all of the 3 tumor types share 2 common features such as dual cell population and vasculocentric pattern. GG smears were characteristically composed of dysplastic ganglion cells and piloid-like astrocytes on a complex architectural background of thin- to thick-walled vessels. DNT, on the other hand, showed oligodendroglial-like cells in a myxoid thin fibrillary background associated with a delicate capillary network. Common cytological features of PGNT were hyperchromatic cells with narrow cytoplasm surrounding hyalinized vessels forming a pseudopapillary pattern and bland cells with neuroendocrine nuclei dispersed in a neuropil background. Conclusion: A higher diagnostic accuracy can be obtained when squash smears are applied with frozen sections. However, it is important to integrate clinical and radiologic features of the patient as well as to know the cytopathologic features of the LEAT spectrum in the context of differential diagnosis to prevent misinterpretation in the IC.

Influence of multimorbidity and socioeconomic factors on long-term cross-sectional health care service utilization in heart transplant recipients: A Danish cohort study

Survival after heart transplantation has increased due to continuously refined and effective care management. Knowledge is sparse on the influence of multimorbidity and social vulnerability on management. We assessed the long-term influence of multimorbidity and socioeconomic factors on cross-sectional health care service utilization in heart transplant recipients. First-time heart transplant recipients, from the Transplant Center at Aarhus University Hospital, were followed from transplant until December 31, 2018. We linked individual-level data from the Scandiatransplant Database to Danish national registers. We followed recipients for 15 years using descriptive statistic. We identified 325 recipients; 79% were male and 60% were between 41 and 60 years of age. The median (IQR) number of chronic conditions at baseline was 1.0 (1.0-2.0). The prevalence of recipients with ≥3 chronic conditions in the follow-up period 0 to 1 year was 10% and 65% within 10 to 15 years. The median use of cross-sectional health care services was higher in recipients with ≥3 chronic conditions compared to <3 chronic conditions during follow-up intervals. The median utilization of hospital outpatient visits and consultations in general practice were higher in recipients with low educational level, low employment status, or low income, respectively. We observed lower median number of redeemed prescriptions for medical therapies in recipients living alone or within the lowest income group. The use of cross-sectional health care services was higher in heart transplant recipients with increased incidence of comorbidities during follow-up intervals. A socioeconomic influence was observed in the utilization of services.

In the beginning was . . . the word. Cycles of Influence: A historical analysis of some seminal influences on the evolutionary development of mediation principles, values and practice models

A historical analysis of seminal influences on the evolutionary development of mediation principles, values and practice models. This article will focus on the ideas of pioneering individuals who had a significant role and influence on contemporary mediation principles and practice. It will describe their professional field of practice; the particular principles and values that underpinned their practice; the theoretical models and styles of practice they developed and how those became transported into contemporary mediation practice. The relevance for mediation is to raise awareness of the centrality, significance, and importance of these key principles. Ideally, this will in turn impact on the quality of contemporary practice. Hopefully it will inform or remind reflective practitioners, trainers, and practice consultants of what constitutes the foundations of best practice.

Collaborative domestication

This article proposes an extension to domestication theory by introducing the concept of collaborative domestication, which we define as the ongoing mutual influence and interdependence of technology users in specific interactional contexts. This concept arose from our investigation of how patients integrate healthcare-related video consultations into their daily lives. In Denmark, the Covid-19 pandemic has expedited the implementation of video consultations in general practice, yet little is known about their use in this context. To address this, we conducted 13 interviews with patients and analysed the interviews from the perspective of domestication theory. We find that the general practitioner plays a central role throughout patients’ domestication processes, and the doctor–patient relationship significantly influences how patients experience video consultations. We argue that there is a collaborative aspect to domesticating video consultations that needs to be considered in both future studies and the ongoing implementation of video consultations

Contacts to general practice in the 12 months preceding a diagnosis of an abdominal cancer: a national register-based cohort study

Objective To compare the number of contacts to general practice across 11 types of abdominal cancer in the 12 months preceding a diagnosis. Design Nationwide register study. Setting Danish general practice. Subjects Forty-seven thousand eight hundred and ninety-eight patients diagnosed with oesophageal, gastric, colon, rectal, liver, gall bladder/biliary tract, pancreatic, endometrial, ovarian, kidney or bladder cancer in 2014–2018. Main outcome measures Monthly contact rates and incidence rate ratios (IRRs) of daytime face-to-face, email and telephone consultations in general practice across different abdominal cancers. The analyses were conducted for each sex and adjusted for age, comorbidity, marital status and education. Results Compared to women with colon cancer, women with rectal cancer had the lowest number of contacts to general practice (IRR 12 months pre-diagnostic (IRR–12)=0.86 (95% CI: 0.80–0.92); IRR 1 month pre-diagnostic (IRR–1)=0.85 (95% CI: 0.81–0.89)), whereas women with liver (IRR–12=1.23 (95% CI: 1.09–1.38); IRR–1=1.11 (95% CI: 1.02–1.20)), pancreatic (IRR–12=1.08 (95% CI: 1.01–1.16); IRR1=1.52 (95% CI: 1.45–1.58)) and kidney cancer (IRR–12=1.14 (95% CI: 1.05–1.23); IRR–1=1.18 (95% CI: 1.12–1.24)) had the highest number of contacts. Men showed similar patterns. From seven months pre-diagnostic, an increase in contacts to general practice was seen in bladder cancer patients, particularly women, compared to colon cancer. Conclusions Using pre-diagnostic contact rates unveiled that liver, pancreatic, kidney and bladder cancers had a higher and more prolonged use of general practice. This may suggest missed opportunities of diagnosing cancer. Thus, pre-diagnostic contact rates may indicate symptoms and signs for cancer that need further research to ensure early cancer diagnosis. Key points The majority of cancer patients attend their general practitioner (GP) before diagnosis; however, little is known about the use of general practice across different abdominal cancers. This study suggests that a potential exists to detect some abdominal cancers at an earlier point in time. The contact patterns in general practice seem to be shaped by the degree of diagnostic difficulty. GPs may need additional diagnostic opportunities to identify abdominal cancer in symptomatic patients.

A Case Report of a &amp;lt;i&amp;gt;Microsporum gypseum&amp;lt;/i&amp;gt; Tinea Capitis Diagnosed at the Laboratory of Parasitilogy-mycology of the Avicenne Military Hospital of Marrakech

Historically, tinea capitis has been a problem among the population in general and in Morocco in particular. It is still a significant reason for consultation in routine medical practice, particularly among the population living in poor hygienic conditions. It is an infection almost exclusively of preschool and school-age children, due to changes in sebaceous secretion and skin pH during puberty, affecting both sexes, with a female predominance. Inflammatory cases or Kerion are caused by zoophilic species such as <i>Trichophyton mentagrophytes, Trichophyton verrucosum, Microsporum canis</i>, and less frequently by <i>Microsporum gypseum</i>. The identification of the species makes it possible to pinpoint the source of contamination and to condition the prophylaxis. Aware of the rarity of inflammatory tinea capitis caused by M. gypseum, we thought it would be interesting to report a new case diagnosed in the Parasitology-Mycology laboratory of the Avicenne Military Hospital in Marrakech, while focusing on the epidemiological, clinical and mycological characteristics of this dermatophyte through a review of the literature.

Telephone Clinics During the Covid-19 Pandemic-The Experiences of Interstitial Lung Disease Patients and Their Carers.

The COVID-19 pandemic has resulted in a widespread move towards virtual consultations within secondary care due to infection concerns. This service evaluation undertaken in a Welsh Interstitial Lung Disease (ILD) specialist center looks at the experiences of unselected ILD patients and their careers with telephone consultations and aims to identify the role of telephone consultations in future practice for this patient group. A mixed methods approach was used with an initial postal questionnaire followed by a virtual focus group. From the 84 patient and 26 carer questionnaire responses, there was broad support for telephone consultations from both groups. The main perceived benefit was reduced infection risk, although face-to-face consultations were seen as holding more value. Themes identified in the virtual focus group of 6 participants recognized the need to balance quality of care against practical considerations. In conclusion, there was support for future telephone consultations if patients and clinicians have flexibility in determining when this occurs, instead of a face-to-face consultation.

WhatsApp-Based virtual consultation in clinical practice during COVID times: A prospective institutional study.

Background:As the novel coronavirus disease 2019 (COVID-19) continues its pandemic surge globally, the attention toward the treatment of non-COVID diseases has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular health-care non-COVID diseases. In this context, we evaluated our own experience with virtual consultation (VC) for the management of endocrine surgical patients during the current COVID pandemic.Materials and Methods:This prospective study was conducted in the endocrine surgery department spanning 4 months from April to July 2020. We employed WhatsApp-based group video conferencing for VC with both new and follow-up outpatients. We evaluated the satisfaction quotient of patients, regarding the three types of consultations (no consultation, VC, and direct consultation) on an ordinal scale of three modes of consultation.Results:Virtual consultation was performed with 102 new and 285 follow-up patients. Goiters, clinical findings, and wounds/scars (in post-operative cases) were evaluated virtually. Dosage of thyroxine replacement, calcium supplementation, and other medications was prescribed based on findings and history. Patients who needed surgery (25/102 cases) were given appropriate appointment. More than 82% of the patients in both groups preferred VC during this COVID pandemic.Conclusions:More than 82% of both new and follow-up patients preferred VC over direct or no consultation during this COVID pandemic. Our findings suggest that VC through social media platforms is capable of ensuring appropriate treatment and follow-up for endocrine diseases.

Phimosis - Are we on right track?

Background:Phimosis, a common paediatric condition, is defined as the inability to retract the preputial skin behind the glans. Current practice shows there is some confusion among the paediatricians towards this common condition and in differentiating it from the more common physiological preputial adhesion; leading to frequent referrals to a paediatric surgeon or a general surgeon, which can be addressed by the parents and the child physicians themselves.Aim:To find out the awareness towards the management of phimosis among the paediatricians.Materials and Methods:A questionnaire on this topic was generated using ‘Google Forms’ and was circulated among junior and senior residents, faculty in various medical colleges and consultants in private practice all over India and their response was collected and analysed.Results:We received a total of 221 responses from all over India from paediatric medicine trainees and consultants. Among them, majority (48%) were senior residents. According to the survey participants, the most (46%) find inability to retract the prepuce as the major presenting complaint. A straight away reference to a paediatric surgeon was preferred by majority of paediatricians (62.9%), though most of them were aware of them were aware of physiological adhesions and conservative management (94.2%). There was a belief among 43% about counselling each and every patient presenting with phimosis for circumcision. Among the respondents, 60.2% advised ultrasound of kidneys, ureter, and bladder to their patients and believed that backpressure changes alter the management of the child. A urine routine examination was advised by 70.1% of participants, with 46.6% believing that the presence of urinary tract infection changes the management of phimosis. Waiting up to 1 year of age before going for surgery was advocated by 71.5%. A major proportion of respondents (76%) believed all cases of phimosis should be referred to a surgeon, only 58.8% would voluntarily follow them up. There is still a belief among 69.7% of participants that all cases of phimosis should be referred to a paediatric surgeon and only few of them, 5.4% feel referring only indicated cases.Conclusion:Physiological phimosis is a common condition which can be addressed by the paediatricians themselves. Awareness is to be increased among them, especially during the training period regarding the proper management of this common condition, avoiding unnecessary circumcisions.