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Objective: This qualitative research project was undertaken to discover how students perceive the embedded librarian in their nursing class. The researchers determined how a required group research meeting was valued by students and whether that value warranted the necessary time and energy by an embedded librarian. Methods: Researchers conducted focus groups with twenty-three students from two different sections of the same nursing research methods undergraduate course. Students' responses to a series of five questions were recorded within Zoom and supplemented by handwritten notes. Data was coded by hand and patterns that emerged from the five focus groups were analyzed. Results: Participants reported overall satisfaction with the embedded librarian and students felt they benefitted from the required research meeting with the librarian, which was part of the searching assignment rubric and closely tied to the assignment itself. Conclusion: Based on the data, a required research meeting with an embedded librarian, who is familiar with the course assignments, reinforces classroom instruction, point-of-need assistance with search strategies, and the opportunity to strengthen the relationship with the librarian for future research needs. [ABSTRACT FROM AUTHOR]

Abstract Background Cancer patients report that they lack support from healthcare providers when it comes to returning to or maintaining employment. In the education of general practitioners (GPs) in the Netherlands, there is little attention given to discussing work participation with patients. The aim of this pilot study was to evaluate a newly developed education program for GPs in training that focuses on discussing work participation with cancer patients. Methods Two groups of in total twenty-one GPs in training participated in the education program. GPs were educated about the importance of discussing work participation with patients, work-related problems cancer patients can experience, and advice they can give to support cancer patients regarding work issues. In this pilot study using a mixed-method design, participants evaluated the program in two self-developed questionnaires and in a focus group discussion. Results Seventeen participating GPs (81%) indicated that the education program was suitable for implementation in the education curriculum. Eleven participants (52%) reported that they had never discussed work participation with cancer patients before. Directly after the education program, eighteen participants (86%) reported that they planned to discuss work participation more often with their patients. Four months after the program, 67% indicated they had applied their new knowledge and skills in practice by discussing work participation and by referring cancer patients to occupational health professionals or online resources. According to the GPs in training, integrating the topic of work participation into other education for GPs in training and focusing on a broader group of patients could improve the impact of the education program. Conclusions According to the results of this pilot study, the newly developed education program increased the awareness of GPs in training on the importance of discussing work participation with cancer patients. Future studies should focus on whether cancer patients experience more support from their GPs for maintaining and returning to employment after their GP has participated in the training program.

Jasmin Bossert,1 Helena Dürsch,1 Bianca Korus,1 Ursula Boltenhagen,2 Mette Stie,3,4 Nadja Klafke1 1Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany; 2Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany; 3Department of Oncology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; 4Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, DenmarkCorrespondence: Jasmin Bossert, Email JasminBossert@gmx.deAbstract: Qualitative evaluation of healthcare consultations offers a profound understanding of the communication dynamics between healthcare providers and patients, fostering active patient involvement in their treatment. This scoping review aims to provide an overview of existing qualitative evaluation methods used in the context of monoprofessional as well as interprofessional consultations. Studies including qualitative and mixed-methods approaches published between 1990 and 2020 were examined across PubMed, PsycINFO, EBSCO CINAHL, Cochrane, and PEDro databases. Utilizing the JBI appraisal checklist for quality assessment, 54 studies were included (51 mono professional, 3 interprofessional consultations). Furthermore, this review identified 58 diverse qualitative methods, with content analysis emerging as the most prevalent. Qualitative methods pose both challenges and opportunities, urging researchers to carefully consider their suitability for specific research objectives. By presenting various qualitative assessment methods, it is possible to evaluate consultations in depth and thereby strengthen communication between patients and providers.Keywords: consultations, content analysis, interprofessional collaboration, patient-oriented communication, qualitative methods, evaluation

Background: Cancer patients report that they lack support from healthcare providers when it comes to returning to or maintaining employment. In the education of general practitioners (GPs) in the Netherlands, there is little attention given to discussing work participation with patients. The aim of this pilot study was to evaluate a newly developed education program for GPs in training that focuses on discussing work participation with cancer patients. Methods: Two groups of in total twenty-one GPs in training participated in the education program. GPs were educated about the importance of discussing work participation with patients, work-related problems cancer patients can experience, and advice they can give to support cancer patients regarding work issues. In this pilot study using a mixed-method design, participants evaluated the program in two self-developed questionnaires and in a focus group discussion. Results: Seventeen participating GPs (81%) indicated that the education program was suitable for implementation in the education curriculum. Eleven participants (52%) reported that they had never discussed work participation with cancer patients before. Directly after the education program, eighteen participants (86%) reported that they planned to discuss work participation more often with their patients. Four months after the program, 67% indicated they had applied their new knowledge and skills in practice by discussing work participation and by referring cancer patients to occupational health professionals or online resources. According to the GPs in training, integrating the topic of work participation into other education for GPs in training and focusing on a broader group of patients could improve the impact of the education program. Conclusions: According to the results of this pilot study, the newly developed education program increased the awareness of GPs in training on the importance of discussing work participation with cancer patients. Future studies should focus on whether cancer patients experience more support from their GPs for maintaining and returning to employment after their GP has participated in the training program. [ABSTRACT FROM AUTHOR]

Aim: This project sought to ascertain views and experiences of people with intellectual disabilities, their carers', and specialist intellectual disability psychiatrists as to use of telepsychiatry consultations. Background: During the Covid-19 pandemic specialist psychiatrists in intellectual disability services in the United Kingdom (UK) have explored and adopted use of telepsychiatry for psychiatric consultations. Method: An easy-read co-designed questionnaire was sent to potential respondents N = 590 potential respondents (N = 280 patients, N = 280 carers), and a separate questionnaire was sent electronically to N = 30 specialist intellectual disability psychiatrists. Findings: Responses were received from N = 192 respondents (N = 68 (24%) patients, N = 98 (35%) carers, and N = 26 (90%)) psychiatrists. Advantages of telepsychiatry cited were flexibility, and it being less disruptive to patients' routines, offering convenient practice and saving travel time and cost. Disadvantages reported included loss of rapport and relationship with patients, and an inability to conduct an effective mental state examination. Conclusion: This survey has produced equivocal evidence as to acceptability of telepsychiatry for all people with intellectual disabilities, carers and psychiatrists cannot be assumed. Some patients may need significant support to enable them to engage with such an approach. [ABSTRACT FROM AUTHOR]

Background: The emergency department (ED) is a demanding and time‐pressured environment where doctors must navigate numerous team interactions. Conflicts between health care professionals frequently arise in these settings. We aim to synthesize the individual‐, team‐, and systemic‐level factors that contribute to conflict between clinicians within the ED and explore strategies and opportunities for future research. Methods: Online databases PubMed and Web of Science were systematically searched for relevant peer‐reviewed journal articles in English with keywords relating to "conflict" and "emergency department," yielding a total of 29 articles. Results: Narrative analysis showed that conflict often occurred during referrals or admissions from ED to inpatient or admitting units. Individual‐level contributors to conflict include a lack of trust in ED workup and staff inexperience. Team‐level contributors include perceptions of bias between groups, patient complexity, communication errors, and difference in practice. Systems‐level contributors include high workload/time pressures, ambiguities around patient responsibility, power imbalances, and workplace culture. Among identified solutions to mitigate conflict are better communication training, standardizing admission guidelines, and improving interdepartmental relationships. Conclusions: In emergency medicine, conflict is common and occurs at multiple levels, reflecting the complex interface of tasks and relationships within ED. [ABSTRACT FROM AUTHOR]

Background: Young‐onset dementia (YOD) community care requires personalised approaches. Yet, the specific details of YOD consultations are unclear. This study explored how initial consultations correlate with client profiles. Methods: Data from regional YOD helplines were used to analyze the main characteristics of people living with YOD or who had concerns about the possibility of YOD (n = 132). Among several categorical variables, the following were used for analysis: age group, sex, type of living arrangement, employment status, presence of dementia, and content of the consultation. To identify groups of items that frequently occur together, strongly connected rules were identified using association rule analysis with the a priori algorithm. To focus on the characteristics of clients, rules related to client characteristics were extracted based on the type of consultation. Results: A total of 51 rules were identified for the consultations. These rules fell into two categories: (1) consultations for medical matters, which mainly involved employed individuals with undiagnosed dementia, and (2) other consultations on daily life or work, which mainly involved individuals diagnosed with dementia and were characterised by the influence of sex. These rules indicate the importance of medical involvement in confirming the diagnosis and specific individualised care following diagnosis for people living with YOD. Conclusion: Clients with or without a dementia diagnosis were consulted differently in the YOD helplines. Before receiving a diagnosis, medical matters were the main theme of consultations, whereas after receiving a diagnosis, adjustments to daily life or work were the main themes. The results of this study suggest that the needs of people living with YOD and the services they require may vary depending on their backgrounds. [ABSTRACT FROM AUTHOR]

Educating patients about the drugs they take is essential for them to take them safely and effectively. This education is now commonly given by nurses as part of the huge expansion in the nurse specialist role. However, training for this role has not kept pace with practice. Nurses have expressed variable confidence in this role and expressed a wish for more formal training. Current practice often puts the information rather than the patient at the centre of the consultation with the nurse dominating the conversation. Cues to address the patient agenda are commonly missed. An animated patient who interrupts is probably not having their educational needs met. Education of the professionals around how to perform this task in an optimal way is necessary and should result in better efficacy and safety of the drugs. This could be achieved by incorporating features of Shared Decision Making and the Calgary–Cambridge consultation techniques into training and the consultation. Personalization by attention to patient preferences, language and health literacy is essential. [ABSTRACT FROM AUTHOR]

Background: Consultations to pediatric allergy/immunology are of benefit to many hospitalized inpatients, but there is limited current information about how T-cell receptor excision circles (TREC) screening may have changed these patterns for pediatric populations. We aimed to determine the types of consults being requested and their relative frequencies for primary pediatric allergy/immunology consults under an academic fellowship program since the start of TREC screening in 2016. Information gained could help identify focal concepts for pediatric allergy inpatient training curricula for fellowship and graduate medical education programs. Methods: Under an IRB approved study of an academic allergy fellowship consultation log, we retrospectively reviewed electronic medical records of pediatric allergy and immunology consults and categorized consultations by their primary indication. Results: Three-hundred and eighty-three pediatric allergy/immunology consultations were seen between September 4, 2016 to November 24, 2022. In terms of frequency, the most common consultation was for immunodeficiency evaluation or treatment, n=205 (53.5%), followed by drug allergy n=55 (14.4%), general allergy concerns n=43 (11.2%), skin allergy n=35 (9.1%), and less commonly inflammatory syndromes, n=26 (6.8%) and food allergy, n=19 (5.0%). Questions related to TREC screening comprised 21% of all immunodeficiency consults, at n=43. Conclusion: At an academic allergy center where all allergy/immunology service lines are currently provided, the most common reason for pediatric consultations were for help with immunodeficiency evaluation/treatment and drug allergy. TREC screening is a new key indication for consultation. Fellowship programs may benefit from focusing on these content areas for the pediatric inpatient setting.

Objective: This qualitative research project was undertaken to discover how students perceive the embedded librarian in their nursing class. The researchers determined how a required group research meeting was valued by students and whether that value warranted the necessary time and energy by an embedded librarian. Methods: Researchers conducted focus groups with twenty-three students from two different sections of the same nursing research methods undergraduate course. Students’ responses to a series of five questions were recorded within Zoom and supplemented by handwritten notes. Data was coded by hand and patterns that emerged from the five focus groups were analyzed. Results: Participants reported overall satisfaction with the embedded librarian and students felt they benefitted from the required research meeting with the librarian, which was part of the searching assignment rubric and closely tied to the assignment itself. Conclusion: Based on the data, a required research meeting with an embedded librarian, who is familiar with the course assignments, reinforces classroom instruction, point-of-need assistance with search strategies, and the opportunity to strengthen the relationship with the librarian for future research needs.

Abstract Background Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. Methods We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. Results GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. Conclusion The GPs’ interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.

Bader A Al-Mehmadi,1 May Musaad M Alelaiwi,2 Haya Sulaiman A Alnumayr,3 Basil Saeed Alghamdi,4 Bandar Abdullah Alomari,4 Hayat Saleh Alzahrani5 1Department of Internal Medicine, College of Medicine, Majmaah University, Al-Majmaah, 11952, Saudi Arabia; 2College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia; 3College of Medicine, Qassim University, Buraydah, Saudi Arabia; 4Department of Internal Medicine, King Fahad Hospital, Medina, Saudi Arabia; 5Department of Family and Community Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Hayat Saleh Alzahrani, Department of Family and Community Medicine, College of Medicine, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia, Tel +96611822000, Email Hsaalzahrani@pnu.edu.sa; hayatsalzahrani@gmail.comPurpose: The aim of this study is to determine the general population’s knowledge on the different symptoms of rheumatic diseases, the key factors for diagnosis delays from the patient’s perspective, the length of delay from the onset of symptoms to the diagnosis, and the effect this holds on the disease activity, response to therapy, and the development of complications and nonreversible deformities in patients diagnosed with rheumatic diseases.Patients and Methods: This is a cross-sectional study. Our target study population were the residents of Saudi Arabia. Data were collected via an online questionnaire and analyzed with SPSS.Results: The overall prevalence of rheumatic disease in our cohort was 8.7%. Joint pain (75.7%), joint swelling (47.1%) and morning stiffness (32.9%) were the first and most common presenting symptom. Persistence of symptoms (N=32, 45.7%) and symptom worsening (N=21, 30.0%) was the predominant cause to visit rheumatologist. The duration between first symptom and rheumatic disease diagnosis is significantly longer for patients aged < 50 years compared to that of those with ≥ 50 years of age. Results show that 36.4% of patients aged ≥ 50 years had delayed diagnosis due to late appointment compared with 5.7% of patients aged < 50 years. In addition, patients with longer duration of symptoms were likely to have more visits to the rheumatologist. Most of the participants of < 50 years significantly agreed that rheumatologists treat autoimmune diseases, only a few approved that they treat muscle problems.Conclusion: Most participants in our study have lesser knowledge about their symptoms and they did not know where to consult for the treatment of their disease. This caused unnecessary delays and worsening and aggravation of the symptoms. There is an increased need to organize an awareness campaign in the general population regarding autoimmune and rheumatic diseases.Keywords: rheumatic diseases, delayed diagnosis, misdiagnosis, referrals, consultations, Saudi Arabia

Physical activity and exercise (PAE) improve quality of life and reduce the effects of chronic diseases. Primary care physicians (PCPs) play an important role to encourage PAE in patients. We aim to assess PCPs' current PAE consultation practices and their enablers/barriers in daily clinical practice. We had 64 PCPs (age [35.3 ​± ​4.7] y, 47 women) that completed self-administered questionnaires on PAE consultation practices, training, and confidence levels. PCPs (n ​= ​42) also completed the International Physical Activity Questionnaire-Short Form to assess their physical activity (PA) levels. We conducted correlation, one-way analysis of variance and a linear regression to assess the associations between enablers, barriers and PA levels to PAE consultation practices. On average, PCPs consulted on PAE in 49.7% of their daily clinical appointments. Majority of PCPs (70%) strongly agreed that more PAE knowledge were needed to increase consultation practices. Top three barriers related (p ​

Background: Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. Methods: We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. Results: GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. Conclusion: The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group. [ABSTRACT FROM AUTHOR]

Physical activity and exercise (PAE) improve quality of life and reduce the effects of chronic diseases. Primary care physicians (PCPs) play an important role to encourage PAE in patients. We aim to assess PCPs' current PAE consultation practices and their enablers/barriers in daily clinical practice. We had 64 PCPs (age [35.3 ± 4.7] y, 47 women) that completed self-administered questionnaires on PAE consultation practices, training, and confidence levels. PCPs (n = 42) also completed the International Physical Activity Questionnaire-Short Form to assess their physical activity (PA) levels. We conducted correlation, one-way analysis of variance and a linear regression to assess the associations between enablers, barriers and PA levels to PAE consultation practices. On average, PCPs consulted on PAE in 49.7% of their daily clinical appointments. Majority of PCPs (70%) strongly agreed that more PAE knowledge were needed to increase consultation practices. Top three barriers related (p < 0.001) to practices were lack of PAE education (r = 0.47), patients’ preference of pharmaceutical interventions (r = 0.45) and lack of continuing education in PAE for PCPs (r = 0.37). Physically active PCPs (health-enhancing PA levels, n = 6) gave significantly more daily consultations in PAE, 73.2% ± 21.9%, compared to inactive PCPs (n = 13), 37.4% ± 22.8% (p = 0.013). In our regression output, PCPs who had higher PA levels consulted more on PAE daily (R² = 0.38, p < 0.001) while controlling for age. Conclusion, PCPs require more knowledge on PAE and need be physically active themselves to increase PAE consultation for patients in their daily practice. Medical education should consider including more PA and exercise topics that may benefit both physicians and their patients. [ABSTRACT FROM AUTHOR]

Prompt neuro-ophthalmology consultation prevents diagnostic errors and improves patient outcomes. The scarcity of neuro-ophthalmologists means that the increasing outpatient demand cannot be met, prompting many emergency department (ED) referrals by non–neuro-ophthalmologists. We describe our quaternary care institution's ED and inpatient neuro-ophthalmology consultation patterns and patient outcomes. Prospective observational study. Consecutive neuro-ophthalmology ED and inpatient consultation requests over 1 year. We collected patient demographics, distance traveled, insurance status, referring provider details, consultation question, final diagnosis, complexity of consultation, time of consultation, and need for outpatient follow-up. Consultation patterns and diagnoses, complexity, and follow-up. Of 494 consecutive adult ED and inpatient neuro-ophthalmology consultations requested over 1 year, 241 of 494 consultations (49%) occurred at night or during weekends. Of ED consultations (322 of 494 [65%]), 127 of 322 consultations (39%) occurred during weekdays, 126 of 322 consultations (39%) occurred on weeknights, and 69 of 322 consultations (22%) occurred on weekends or holidays. Of 322 ED consultations, 225 of 322 consultations (70%) were patients who initially sought treatment in the ED with a neuro-ophthalmic chief symptom. Of the 196 patients sent to the ED by a health care professional, 148 patients (148/196 [76%]) were referred by eye care specialists (74 optometrists and 74 ophthalmologists). The most common ED referral questions were for papilledema (75 of 322 [23%]) and vision loss (72 of 322 [22%]). A total of 219 of 322 patients (68%) received a final active neuro-ophthalmic diagnosis, 222 of 322 patients (69%) were cases of high or very high complexity, and 143 of 322 patients (44%) required admission. Inpatient consultations (n = 172) were requested most frequently by hospitalists, including neurologists (71 of 172 [41%]) and oncologists (20 of 172 [12%]) for vision loss (43 of 172 [25%]) and eye movement disorders (36 of 172 [21%]) and by neurosurgeons (58 of 172 [33%]) for examination for mass or a preoperative evaluation (19 of 172 [11%]). An active neuro-ophthalmic diagnosis was confirmed in 67% of patients (116 of 172). Outpatient neuro-ophthalmology follow-up was required for 291 of 494 patients (59%). Neuro-ophthalmology consultations are critical to the diagnosis and management in the hospital setting. In the face of a critical shortage of neuro-ophthalmologists, this study highlights the need for technological and diagnostic aids for greater outpatient access. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Introduction: The main aim of this study was to investigate the relationship between employee participation in decision-making and the performance of organizations. The objectives of the study were; to examine the influence of consultative participation in decision-making on performance. Methodology: The study adopted both descriptive and correlational survey research designs based on a quantitative method of data. The study population was 132 out of which a sample of 118 respondents was selected as the study sample and it was randomly selected. Questionnaires and interviews were used as data collection methods. Results: The results of the study revealed a strong positive and significant correlation between consultative decision-making and performance (r= 0.651, p=0.000). Conclusion: The findings of the study indicated that consultations within organizations are the most required strategy of decision-making within public institutions like KCCA in Uganda. Recommendation: The study recommends that KCCA should focus on improving the working schedules to make them more flexible as this increases the commitment of employees.

Background: The recent publication of data on appointment volumes for all general practices in England has enabled representative analysis of factors affecting appointment activity rates for the first time. Aim: To identify population, workforce, and organisational predictors of practice variations in appointment volume. Design and setting: A multivariable cross-sectional regression analysis of 6284 general practices in England was undertaken using data from August–October 2022. Method: Multivariable regression analyses was conducted. It related population age and deprivation, numbers of GPs, nurses, and other care professionals, and organisation characteristics to numbers of appointments by staff type and to proportions of appointments on the same or next day after booking. Results: Appointment levels were higher at practices serving rural areas. Practices serving more deprived populations had more appointments with other care professionals but not GPs. One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over 3 months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional over 3 months). There was evidence of substitution between staff types in appointment provision. Levels of staffing were not associated with proportions of same-or next-day appointments. Conclusion: Higher staffing levels are associated with more appointment provision, but not speed of appointment availability. New information on activity levels has shown evidence of substitution between GPs and other care professionals in appointment provision and demonstrated additional workload for practices serving deprived and rural areas. [ABSTRACT FROM AUTHOR]

Simple Summary: The COVID-19 pandemic has driven the expansion of remote consultations in medical care. However, their implementation in neuro-oncology comprises unique challenges and opportunities. Evidence for how the complex patient–doctor relationships and neurological examinations required in the treatment of brain tumor patients can be translated to video consultation is scarce. Therefore, we analyzed over 3700 consultations at our institution in order to determine how patients that decided to participate in remote consultations distinguished from patients that did not. Additionally, we queried them about their reasons, encounters, problems/limitations, opportunities, emotional impact and future directions regarding their experiences with telemedicine during their treatment with an anonymized survey. With this, we are able to provide guidance on suitable patient subgroups, occasions and future directives to expand and adapt telemedicine patient care in neuro-oncology in an individualized and evidence-based concept. In order to minimize the risk of infections during the COVID-19 pandemic, remote video consultations (VC) experienced an upswing in most medical fields. However, telemedicine in neuro-oncology comprises unique challenges and opportunities. So far, evidence-based insights to evaluate and potentially customize current concepts are scarce. To fill this gap, we analyzed >3700 neuro-oncological consultations, of which >300 were conducted as VC per patients' preference, in order to detect how both patient collectives distinguished from one another. Additionally, we examined patients' reasons, suitable/less suitable encounters, VC's benefits and disadvantages and future opportunities with an anonymized survey. Patients that participated in VC had a worse clinical condition, higher grade of malignancy, were more often diagnosed with glioblastoma and had a longer travel distance (all p < 0.01). VC were considered a fully adequate alternative to face-to-face consultations for almost all encounters that patients chose to participate in (>70%) except initial consultations. Most participants preferred to alternate between both modalities rather than participate in one alone but preferred VC over telephone consultation. VC made patients feel safer, and participants expressed interest in implementing other telemedicine modalities (e.g., apps) into neuro-oncology. VC are a promising addition to patient care in neuro-oncology. However, patients and encounters should be selected individually. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac diseases in the pediatric population can be congenital or acquired. If the diagnosis and treatment are early, the chance for survival increases. Thus, this study aimed to determine the indications for pediatric cardiology consultations in a single tertiary hospital in Jeddah, Saudi Arabia. Materials and Methods: This study was conducted in 2020-2021 at a tertiary center in Jeddah, Saudi Arabia. Patients younger than 14 years of age who were referred by outpatient clinics or those who presented to the emergency department and needed outpatient cardiac evaluation were included in this study. Inpatient referrals were excluded. The Statistical Package for the Social Sciences version 21 was used for statistical analyses. Results: A total of 416 referred patients were included in this study. New patients accounted for 74% of the referrals, while known patients accounted for 26%. The median age was 2.728 years, with 56.3% being male participants. The three most common reasons for referral were: evaluation of cardiac function (21.6%), follow-up evaluation of fetal/neonatal diagnosis (19.5%), and heart murmurs (16.8%). Conclusion: Most of the referrals were new patients. Of those who underwent echocardiography, 48.2% had abnormal results. We recommend further studies to help guide the direction of the residents' education and to provide better patient healthcare services. [ABSTRACT FROM AUTHOR]

The question of how best to tackle anthropogenic climate change is a thorny one: besides scientific uncertainty regarding the consequences of climate change, another difficulty is that the recommendations of climate experts may clash with the priorities of citizens, interest groups and political institutions. With the European Green Deal, the European Union (EU) recently made significant advances in climate policy; at the same time, and as is well known, the EU and its institutions have long been criticised for their "democratic deficit" and for their failure to involve all civil society actors equally in EU law-making processes. This article sheds light on the legal framework governing civil society participation in EU law-making, and more specifically on the Commission's consultations pursuant to Article 11(3) of the Treaty on European Union. It then critically assesses selected features of two consultations conducted by the Commission in connection with the European Climate Law, which it evaluates from the perspective of the EU primary law principles of democracy, openness and transparency. Through this analysis, and by suggesting how future climate consultations could be further improved, the article aims to contribute to the (still nascent) legal scholarship on civil society participation in environmental and climate policy. [ABSTRACT FROM AUTHOR]

The need for mental health care for pediatric patients outstrips the supply, especially in states, like Kansas, that experience shortages of mental health professionals. Pediatric mental health care access programs, like KSKidsMAP (Kansas Kids Mental health Access Program), increase access to care by building competence and confidence in primary care physicians and clinicians (PCPs) through a statewide integrated system that includes a consultation line. This study is a secondary analysis of KSKidsMAP consultation Line inquiries regarding patients aged 0 to 21 years with mental and behavioral health concerns. The study employs a mixed-method approach with descriptive statistics and thematic analysis of inquiries. Five themes were identified: (1) pharmacotherapy, (2) diagnostic evaluation, (3) community resources, (4) psychotherapy, and (5) other. This study sheds light on PCPs needs and illustrates the importance of Pediatric Mental Health Care Access programs offering interprofessional expertise to consulting PCPs, allowing for expansion of pediatric mental illness care into the primary care setting. [ABSTRACT FROM AUTHOR]

Objectives: Cardiac diseases in the pediatric population can be congenital or acquired. If the diagnosis and treatment are early, the chance for survival increases. Thus, this study aimed to determine the indications for pediatric cardiology consultations in a single tertiary hospital in Jeddah, Saudi Arabia. Materials and Methods: This study was conducted in 2020–2021 at a tertiary center in Jeddah, Saudi Arabia. Patients younger than 14 years of age who were referred by outpatient clinics or those who presented to the emergency department and needed outpatient cardiac evaluation were included in this study. Inpatient referrals were excluded. The Statistical Package for the Social Sciences version 21 was used for statistical analyses. Results: A total of 416 referred patients were included in this study. New patients accounted for 74% of the referrals, while known patients accounted for 26%. The median age was 2.728 years, with 56.3% being male participants. The three most common reasons for referral were: evaluation of cardiac function (21.6%), follow-up evaluation of fetal/neonatal diagnosis (19.5%), and heart murmurs (16.8%). Conclusion: Most of the referrals were new patients. Of those who underwent echocardiography, 48.2% had abnormal results. We recommend further studies to help guide the direction of the residents' education and to provide better patient healthcare services.

Abstract Background Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow. Methods A scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed. Results The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”. Conclusions The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

Abstract Background Neurological diseases cause numerous challenges in palliative care. Telemedicine may improve the access to specialized expertise in neurology for patients, their relatives, and palliative care physicians. The TANNE study offers teleconsultations by a hospital-based neuropalliative center for specialized outpatient palliative care (SOPC) and hospices. A prospective, partially randomized, controlled trial aims at generating evidence for clinical improvements, quality of life, and cost efficiency. Methods SOPC and hospice teams in Bavaria, Germany, are partially randomized to one of two study arms, namely a treatment group with teleconsultations by specialists for neurology and palliative medicine or to a control group with interventions after a 12-months delay. Individual and population-based measures are assessed with a mixed-methods design in order to evaluate the medical effects, the potential for implementation in standard care, and health economic aspects. The primary outcome consists of the mean change difference between groups in the Integrated Palliative Care Outcome Scale (IPOS), which physicians assess before and after treatment of a neurological event. Besides, several secondary outcomes are investigated, including quality of life, which is measured with the revised McGill Quality of Life Questionnaire (McGill QOL-R) as well as items regarding general and health-related quality of life. Further secondary outcomes include the concrete progress of the neurological signs and symptoms; the subjective change in well-being since the start of the treatment of the neurological diseases from the perspectives of patients, their relatives, as well as medical and nursing professionals; as well as patient, professional, and caregiver satisfaction with the teleconsultations. Moreover, a health economic evaluation compares group differences regarding hospital visits and emergency calls with utilization measurements. Discussion The TANNE trial provides a comprehensive and complex evaluation design for teleconsultations in neuropalliative care. Ethical considerations need to take the patients’ vulnerability into account. The project promises to substantially broaden the width of health care services and to improve the quality of life for deserving patients. Trial registration German Clinical Trials Register ( www.germanctr.de [July 17, 2022], DRKS ID: DRKS00027436. Registered February 10th, 2022, retrospectively registered. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027436 [July 17, 2022].

It's widely acknowledged that Social Work requires a more psychological approach when working with families. However, social care settings are under increased financial constraints and creative solutions are necessary. The provision of psychological consultations may be one way to meet this identified need; however, practice-based research is in its infancy. Using a mixed-methods approach, this service evaluation aimed to evaluate the provision of psychological consultations across community Social Care, and Residential Edge of Care teams. Quantitative analysis revealed that psychological consultations significantly improved consultees' knowledge, confidence, motivation, and understanding – factors associated with best practice. Thematic analysis of the consultees' qualitative feedback resulted in four key themes pertaining to areas of benefit: 'enriching assessments', 'developing formulations', 'improving interventions', and 'supporting reflective professional practice'. Three key themes emerged in relation to what staff viewed as areas for improvement; that is: 'changes to the process of consultation', 'changes to the content of consultation', and 'no improvement necessary'. These findings further evidence the beneficial impact of psychological consultations when provided across a range of Children's Social Care settings. Psychology consultations therefore offer a promising means of promoting psychologically informed Social Care practice, contributing to best practice standards within the context of financial constraints. [ABSTRACT FROM AUTHOR]

BackgroundPhysical activity (PA) has been consistently reported as a crucial component of disease prevention and improvement of people’s health. Nevertheless, data has evidenced a decline in physical activity levels among adults in Jordan. Although previous behavioral change interventions have documented efficacy in increasing physical activity among adults, the PA levels is low among adults. A new motivational intervention that focuses on changing behavior toward performing the recommended level of physical activity is on need.ObjectiveThis two-arm single-center randomized controlled trial aimed to measure the efficacy of a multi-component behavioral intervention (including goal setting, self-monitoring, and feed-back) for increasing physical activity levels and self-efficacy for exercise and decreasing body mass index and blood pressure among students at a Jordanian University.SettingPhiladelphia University in Jordan.MethodsA behavioral intervention based on individualized consultations, text messages reminders and interaction with a Facebook page was compared with educational sessions in terms of efficacy for increasing physical activity levels among students at Philadelphia University.ResultsThe intervention and control groups were comparable at baseline. At 6 months a significant increase was seen in the moderate physical activity and walking levels of the intervention group compared with the control group. The mean change (SD) in total METs of moderate physical activity and walking was 503 (325.20) METs/week in the intervention group and 6 (271.20) METs/week in the control group. The mean change (SD) in steps/day was 3,000 (1,217) steps/day in the intervention group and 876 (1120.23) steps/day in the control group. The difference between mean change of the two groups was very significant at 2,124 (−820 to −563). Self-efficacy for exercise scale significantly increased among the intervention group compared with the control group. In addition, body mass index (BMI) declined from the baseline (Mean: 28.23, SD: 4.82) to 6 months (Mean: 25.36, SD: 5.23) for the intervention group.ConclusionBehavioral intervention through multicomponent strategies, alongside the implementation of an advanced communication strategy via phone and social media, is effective for motivating adult students to increase their physical activity levels.Clinical trial registrationISRCTN54100536.

Background: Electronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow. Methods: A scoping review was carried out using the Arksey and O'Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed. Results: The search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals' subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, "workflow" and dialogue with patients, and clinicians' experience of "alert fatigue". Conclusions: The published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools. [ABSTRACT FROM AUTHOR]

Background: Neurological diseases cause numerous challenges in palliative care. Telemedicine may improve the access to specialized expertise in neurology for patients, their relatives, and palliative care physicians. The TANNE study offers teleconsultations by a hospital-based neuropalliative center for specialized outpatient palliative care (SOPC) and hospices. A prospective, partially randomized, controlled trial aims at generating evidence for clinical improvements, quality of life, and cost efficiency. Methods: SOPC and hospice teams in Bavaria, Germany, are partially randomized to one of two study arms, namely a treatment group with teleconsultations by specialists for neurology and palliative medicine or to a control group with interventions after a 12-months delay. Individual and population-based measures are assessed with a mixed-methods design in order to evaluate the medical effects, the potential for implementation in standard care, and health economic aspects. The primary outcome consists of the mean change difference between groups in the Integrated Palliative Care Outcome Scale (IPOS), which physicians assess before and after treatment of a neurological event. Besides, several secondary outcomes are investigated, including quality of life, which is measured with the revised McGill Quality of Life Questionnaire (McGill QOL-R) as well as items regarding general and health-related quality of life. Further secondary outcomes include the concrete progress of the neurological signs and symptoms; the subjective change in well-being since the start of the treatment of the neurological diseases from the perspectives of patients, their relatives, as well as medical and nursing professionals; as well as patient, professional, and caregiver satisfaction with the teleconsultations. Moreover, a health economic evaluation compares group differences regarding hospital visits and emergency calls with utilization measurements. Discussion: The TANNE trial provides a comprehensive and complex evaluation design for teleconsultations in neuropalliative care. Ethical considerations need to take the patients' vulnerability into account. The project promises to substantially broaden the width of health care services and to improve the quality of life for deserving patients. Trial registration: German Clinical Trials Register (www.germanctr.de [July 17, 2022], DRKS ID: DRKS00027436. Registered February 10th, 2022, retrospectively registered. https://www.drks.de/drks%5fweb/navigate.do?navigationId=trial.HTML&TRIAL%5fID=DRKS00027436 [July 17, 2022]. [ABSTRACT FROM AUTHOR]

Background: The escalating cost of health care has important implications on national economies and public health. Palliative care (PC) consultations have been shown to reduce health costs while improving the quality of life. Aim: To assess the impact of PC consultations on hospital costs in a low- and middle-income country. Methods: We analyzed billing data of patients who received a PC consultation at our tertiary care hospital over a one-year period. Controls were patients with a serious illness who had at least one admission during the study period. Analysis was conducted for patients discharged alive and those who died during their hospitalization. The primary outcome was cost of hospitalization. Readmission rates, length of stay (LOS), and number of emergency department (ED) visits after discharge were secondary outcomes. Results: Daily hospital costs were 10% lower for patients who received a PC consult (n = 346) compared with controls (n = 698). This difference was more pronounced among patients who died during their hospitalization and when the consult was conducted earlier in the hospital course. LOS (4.92 vs. 4.68, p < 0.0001), readmissions (24.78% vs. 36.41%, p < 0.001), and ED visits after discharge were lower in the PC group compared with the control group (relative risk [RR] = 2.46). Conclusions: We used readily available hospital billing data to demonstrate the cost benefits of inpatient PC consultations. This simple approach can provide powerful data to justify the need for PC services. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic saw major changes to small animal veterinary practice, many of which may have had an impact on stress in cats presented to the clinic. The aim of this study was to examine the nature of feline outpatient visits before and during the pandemic, and examine signs of stress noted in cats before, during and after these visits. Methods: A questionnaire was used to gather data on cat owner experiences of visits to the veterinary clinic. Data were gathered on the owner's most recent experience of a consultation, with consultations occurring in February 2020 or earlier coded as a standard consultation, and consultations occurring in March 2020 or later coded as COVID-19 consultations. Results: A total of 371 responses were received, with 210 coded as standard consultations and 161 coded as COVID-19 consultations. Consultation type varied significantly between standard and COVID-19 consultations (P <0.001), with emergency consultations more frequent and preventive healthcare consultations less frequent during the COVID-19 pandemic. The area in which the owner and their cat waited also varied significantly between standard and COVID-19 consultations (P <0.001), with standard consultations more likely to involve time in a waiting room while COVID-19 consultations were often called straight in or waited outside the practice. Most owners notedbehaviours associated with stress in their cats, regardless of consultation type, although trying to hide or escape were noted more frequently for cats seen prior to the COVID-19 pandemic. Conclusions and relevance: The findings suggest that outpatient visits to the veterinary clinic were stressful for cats both prior to and during the COVID-19 pandemic, but some measures taken during the pandemic, for example less use of waiting rooms, could be used alongside existing cat friendly measures to help to reduce stress in feline patients. [ABSTRACT FROM AUTHOR]

Objectives: The importance of the effects of stress on cats is well recognised, with visits to the veterinary clinic a common cause of stress. The aim of this study was to explore owners' experiences of stress, both for themselves and their cat, during veterinary visits, and to gather data on owners' perception of resources within the clinic to reduce stress in their cats. Methods: A questionnaire aimed at cat owners with recent experience of an outpatient visit to the veterinary clinic was developed and distributed. Questions covered demographics; their most recent veterinary visit; their general experience of visits over the past 3 years; measures taken by the clinic to reduce stress; and awareness of the Cat Friendly Clinic programme. There were various question types, with owners often asked to rate stress from 1 (least stressful) to 10 (most stressful). Results: A total of 277 respondents gave details about their experience of consultations over the past 3 years. Owners rated the stress of travelling to the clinic, other animals in the waiting room and the consultation itself (all median 6, interquartile range 4–8) as the most stressful elements. Most owners reported gentle methods of removing the cat from their carrier; however, almost a third (n = 81/263; 30.8%) had seen their cat scruffed during a consultation. Cat-only waiting rooms were viewed as the most effective measure to reduce stress in the clinic. Conclusions and relevance: Veterinary clinics are already taking steps to address stress in cats, and owners have a good awareness of stress in their cats. Future work should focus on trialling specific interventions to determine their effectiveness in reducing stress in feline patients, and measures currently perceived by owners to be highly effective, such as cat-only waiting rooms, should be used where feasible. [ABSTRACT FROM AUTHOR]

Aim: In this study, the aim was to examine the otorhinolaryngology consultations requested from the emergency service and to discuss the results in light of the literature. Materials and Methods: In our study, 376 patients who were admitted to emergency department and who were consulted to the otorhinolaryngology outpatient clinic of Kastamonu Training and Research Hospital between the dates 01.10.2019 and 01.10.2021 were examined retrospectively. The age and gender of patients, date of consultation, reasons for consultation, diagnoses made as a result of consultation, and interventions taken were recorded. Results: 142 (37.8%) of the patients for whom consultations were requested were female and 234 (62.2%) were male. The mean total age was 38.43. The most common reason for consultation was nasal fracture, infectious causes, foreign body in the ear and foreign body in the nose, respectively (n=77, 20.47%; n=51, 13.56%; n=39, 10.37%; n=36, 9.57%). The most frequently consultation requested months are July (n=62, 16.48%), August (n=45, 11.96%) and September (n=44, 11.70%), respectively. As a result of the consultations, the most common interventions were foreign body removal and nasal fracture repositioning (n=64, 17.02%; n=58, 15.42%). No otorhinolaryngology pathology was found in 79 patients (21.01%). Conclusion: The fact that emergency physicians have sufficient knowledge and experience in otorhinolaryngology emergencies will both reduce the mortality and morbidity of patients and prevent the loss of time and internal power by preventing unnecessary consultation requests. [ABSTRACT FROM AUTHOR]

Introduction The activities and consultations undertaken by Māori health provider nurses are likely broad and operate within a Māori nursing model of care. However, there is little quantitative evidence to document and describe these encounters with clients. The Omaha coding system provides a mechanism in which to quantify nursing encounters through classifying client problems by domain, interventions and specific targets relating to interventions. Aim The aim of this study was to document the types of encounters and interventions undertaken by Māori health provider nurses. Methods An audit was undertaken of patient encounters occurring within a Māori health provider between 1 January 2020 and 31 December 2020. Encounters were randomly selected and problems, activities and interventions coded utilising the Omaha coding system. Simple descriptive statistics were used. Results A total of 5897 nurse–client encounters occurred over the study period. Overall, 61% of the audited nurse–client encounters related to the physiological domain and only 6% of encounters were related to the psychosocial domain. And 29% of nursing interventions involved teaching/guiding/counselling and a further 29% of interventions were case management. Discussion The wide variety of conditions seen and the number of interventions carried out indicate the broad scope of Māori health provider nurses. However, there were likely undocumented problems, which could reflect the medicalisation of the electronic health record. Redesigning electronic health records to apply more of a nursing and Māori health provider lens may facilitate more inclusive ways of documentation.

This article deals with the development of the communication capacity index of united territorial communities (UTCs), as the analysis of basic research on the communicative development of communities demonstrates the urgency of the need to measure this process. Therefore, in this work, researchers set the purpose of determining the Communication Capacity Index of UTCs in the context of Ukraine’s European integration policy. To do this, the authors used the method of analysis of statistical data and passport characteristics and the comparative approach. As a result of the analysis of four communication levels (information, consultations, dialogue, partnership) of township UTCs in the Mykolaiv region, the UTCs with the highest and the lowest Communication Capacity Indexes (CCі) were revealed, and are outlined in tables and diagrams. As conclusions of this research, the specifics and regularities of the communication interaction of UTCs (in the example of township UTCs of the Mykolaiv region) are determined.

This article deals with the development of the communication capacity index of united territorial communities (UTCs), as the analysis of basic research on the communicative development of communities demonstrates the urgency of the need to measure this process. Therefore, in this work, researchers set the purpose of determining the Communication Capacity Index of UTCs in the context of Ukraine’s European integration policy. To do this, the authors used the method of analysis of statistical data and passport characteristics and the comparative approach. As a result of the analysis of four communication levels (information, consultations, dialogue, partnership) of township UTCs in the Mykolaiv region, the UTCs with the highest and the lowest Communication Capacity Indexes (CCі) were revealed, and are outlined in tables and diagrams. As conclusions of this research, the specifics and regularities of the communication interaction of UTCs (in the example of township UTCs of the Mykolaiv region) are determined. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to determine how frequently body weight, body condition score (BCS) and terms pertaining to weight status are recorded in the electronic health records (EHRs) of veterinary practices in the UK, as well as to examine the variables affecting recording and associated with body weight, where recorded. Methods: Data recorded in EHRs were searched in two 3-month periods in 2019 and 2020. For each visit, variables including type and time of consultation, signalment, recording of body weight, recording of BCS, weight (kg), BCS value and whether an overweight or weight-loss term was used in free text were recorded. Linear mixed-effects models were created to examine associations between body weight and variables, while mixed-effects logistic regression was used to determine associations between the same variables and weight or BCS recording. Results: The statistical data set comprised 129,076 visits from 129,076 cats at 361 practices. Weight was recorded at most (95.2%) visits, BCS was recorded at only 22.5% of visits, and terms associated with weight loss and overweight status were recorded in 10.0% and 7.2% of free-text records, respectively. Where BCS was recorded, approximately one-third of cats had an overweight score (8.0% of total visits). Using either an overweight term (P <0.001) or weight-loss term (P <0.001) was associated with increased odds of body weight being recorded, while being an out-of-hours (P <0.001) or non-routine consultation (P <0.001) were associated with decreased odds. Increasing age (P <0.001), using a weight-loss term (P <0.001) and using an overweight term (P <0.001) were associated with increased odds of BCS being recorded, while being a non-routine consultation (P <0.001) was associated with decreased odds. Recording BCS was negatively associated with recording body weight and vice versa. Conclusions and relevance: Cats are regularly weighed in UK practice, but BCS is less frequently recorded, and both are less often recorded in non-routine consultations. To improve both the treatment and assessment of health and nutrition in cats, veterinary professionals should record body weight and BCS concurrently at every consultation. [ABSTRACT FROM AUTHOR]

The EU-China Comprehensive Agreement on Investment (CAI) establishes a sophisticated inter-State dispute settlement mechanism, directly inspired by the World Trade Organization (WTO) and adapted to a bilateral context, as is also found in recent preferential trade agreements. The novelty here lies in its extension to the field of investment entry and investment facilitation. Some variations in detail are also important. Because of partial material overlap, it is necessary to consider how choice of forum is organized between CAI procedures and those under WTO or other agreements, and to clarify the possible interplay with bilateral investment treaties previously concluded by China with EU Member States. The attention given in CAI to specific procedures for sustainable development and subsidies is also notable. In sum, the solutions adopted show a willingness on the part of the two powers to exert a certain influence on developments in international investment law, without upsetting the methods of dispute resolution. [ABSTRACT FROM AUTHOR]

At Newcastle Dental Hospital, the addition of a telephone consultation stage to the sedation assessment pathway has received positive feedback from patients. This prompted further evaluation into the impact of telephone consultations on service provision and discussion regarding the potential benefit of telephone consultations in the dental sedation service.. [ABSTRACT FROM AUTHOR]

Background: Clients are invited to play a role in decisions about their care. Collaborative deliberation comprises constructive engagement, recognition of alternative actions, comparative learning, construction and elicitation of preferences and preference integration. Collaborative deliberation between clients and professionals is a process that requires an interest in each other, sharing of views on alternatives and preferences and integrating into decisions. The aim is to gain insight into collaborative deliberation in consultations and the clients' perception of arranging long-term care. Design: A descriptive qualitative study to explore collaborative deliberation in consultations between clients and professionals. Six organisations providing long-term care were included. Data collection of nine clients involved observations of consultation with field notes and audio-records, interviews with clients and professionals shortly and 3–6 months after the consultation and questionnaires to collect background information. The data were analysed by deductive content analysis. Findings: Constructive engagement was visible in all consultations. Clients and professionals showed respect, empathy and curiosity towards each other. In most consultations, two or more alternative actions are recognised and discussed. Comparative learning appears to be two sided, the client and the professional learn from each other's knowledge and experiences. Construction and elicitation of preference, and preference integration, seems to be present, but difficult to recognise in all consultations. Discussion/conclusion: Although all propositions could be identified, there seems room for improvement in preference elicitation and integration of these preferences in the discussions on courses of action. Assistance seems needed with preference elicitation, both for the clients and for the professional. [ABSTRACT FROM AUTHOR]

Tunisia's civil society has widely been identified as one of the factors that prevented the country from following the unfortunate path of other Arab states in which long-term autocrats were ousted in 2011. Hence, the EU has identified it as a key interlocutor, began to provide more substantial support to associations and started to regularly consult with activists. While substantial research has been devoted to the EU's financial assistance for civil society, interactions outside the donor-recipient relationship have received less attention. In line with this special issues' objective to examine how the EU projects democratic norms through its interactions with non-state actors in in the Southern Mediterranean, this article zooms in on its consultations with Tunisian civil society. It finds that the EU is including only a non-representative subset of civil society activists as a result of its practices. To what extent these activists' perspectives and preferences are conveyed to Brussels is not entirely clear either. Moreover, some of its practices strengthen the perception of the EU being a patronizing and paternalistic actor. [ABSTRACT FROM AUTHOR]

Background: High-quality primary care needs to be person-centred, and GPs must communicate effectively to ensure continuity and coordination of care. In Kenya, there is little knowledge about the quality of communication in consultations by GPs. Aim: To evaluate the quality of communication in consultations by GPs. Design & setting: Descriptive, observational study of 23 GP consultations in 13 private sector primary care facilities in Nairobi, Kenya. Method: One consultation with a randomly selected adult patient was recorded per GP, and 16 communication skills evaluated with the Stellenbosch University Observation Tool (SUOT). A total percentage score was calculated per consultation, and compared with the GPs' demographics and the consultation complexity and duration using the Statistical Package for Social Sciences (SPSS, version 25). Results: The GPs' median age was 30.0 years (interquartile range [IQR] 29.0-32.0) and median consultation time was 7.0 minutes (IQR 3.0-9.0). Median overall score was 64.3% (IQR 48.4-75.7). GPs demonstrated skills in gathering information, making and explaining the diagnosis, and suggesting appropriate management. GPs did not make an appropriate introduction, explore the context or patients' perspectives, allow shared decision making, or provide adequate safety netting. There was a positive correlation between the scores and duration of the consultations (r = 0.680; P = 0.001). The score was higher in consultations of moderate complexity (78.1, IQR 57.1-86.7) versus low complexity (52.2, IQR 45.1-66.6) (P = 0.012). Conclusion: Consultations were brief and biomedical by young GPs. GPs need further training in communication skills, particularly with regard to delivering person-centred consultations. Deploying family physicians to the primary care setting would also improve the overall quality of service delivery. [ABSTRACT FROM AUTHOR]

EU agencies have become important regulatory venues. Initially established to provide expert advice, many have gained far-reaching decision-making and enforcement powers. This has attracted considerable attention from stakeholders, but the extent of their influence on EU agency conduct has remained a black box. We employ a novel dataset of 203 consultations (2007–2017) containing 26,468 attempts of stakeholders to change proposed regulatory rules by the European Union Aviation Safety Agency, as well as the agency's response. This dataset allows for an original approach to measuring influence by linking influence attempts to rule changes. We found that business interests are far more influential than diffuse public interests. This has important implications for the legitimacy of EU agency stakeholder policies, as they are meant to make EU agencies more broadly accessible. National regulators are also influential in EU agency consultations, pointing to the unacknowledged importance of stakeholder consultations for EU-national regulator interactions. [ABSTRACT FROM AUTHOR]

Background: Preoperative cardiac risk assessment is an integral part of preoperative evaluation; however, there is significant variation among providers, leading to inappropriate referrals for cardiology consultation or excessive low-value cardiac testing. We implemented a novel electronic medical record (EMR) form in our preoperative clinics to decrease variation., Objective: This study aimed to investigate the impact of the EMR form on the preoperative utilization of cardiology consultation and cardiac diagnostic testing (echocardiograms, stress tests, and cardiac catheterization) and evaluate postoperative outcomes., Methods: A retrospective cohort study was conducted. Patients who underwent outpatient preoperative evaluation prior to an elective surgery over 2 years were divided into 2 cohorts: from July 1, 2021, to June 30, 2022 (pre-EMR form implementation), and from July 1, 2022, to June 30, 2023 (post-EMR form implementation). Demographics, comorbidities, resource utilization, and surgical characteristics were analyzed. Propensity score matching was used to adjust for differences between the 2 cohorts. The primary outcomes were the utilization of preoperative cardiology consultation, cardiac testing, and 30-day postoperative major adverse cardiac events (MACE)., Results: A total of 25,484 patients met the inclusion criteria. Propensity score matching yielded 11,645 well-matched pairs. The post-EMR form, matched cohort had lower cardiology consultation (pre-EMR form: n=2698, 23.2% vs post-EMR form: n=2088, 17.9%; P<.001) and echocardiogram (pre-EMR form: n=808, 6.9% vs post-EMR form: n=591, 5.1%; P<.001) utilization. There were no significant differences in the 30-day postoperative outcomes, including MACE (all P>.05). While patients with "possible indications" for cardiology consultation had higher MACE rates, the consultations did not reduce MACE risk. Most algorithm end points, except for active cardiac conditions, had MACE rates <1%., Conclusions: In this cohort study, preoperative cardiac risk assessment using a novel EMR form was associated with a significant decrease in cardiology consultation and testing utilization, with no adverse impact on postoperative outcomes. Adopting this approach may assist perioperative medicine clinicians and anesthesiologists in efficiently decreasing unnecessary preoperative resource utilization without compromising patient safety or quality of care., (©Mandeep Kumar, Kathryn Wilkinson, Ya-Huei Li, Rohit Masih, Mehak Gandhi, Haleh Saadat, Julie Culmone. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 13.09.2024.)

Abstract Background Measures taking aim at minimizing the risk of coronavirus transmission and fear of infection may affect decisions to seek care for other medical emergency conditions. The purpose of this analysis was to analyze intermediate-term effects of the COVID-19 pandemic on neuroradiological emergency consultations (NECs). Methods We conducted an ambispective study on NEC requests to a university hospital from a teleradiological network covering 13 hospitals in Germany. Weekly NEC rates for prepandemic calendar weeks (CW) 01/2019–09/2020 were compared with rates during first COVID-19 wave (CW 10–20/2020), first loosening of restrictions (CW 21–29/2020), intensified COVID-19 testing (CW 30–39/2020) and second COVID-19 wave (CW 40–53/2020), and contrasted with COVID-19 incidence in Germany. Results A total of n = 10 810 NECs were analyzed. Prepandemic NEC rates were stable over time (median: 103, IQR: 97–115). Upon the first COVID-19 wave in Germany, NEC rates declined sharply (median: 86, IQR: 69–92; p

Single IRB (SIRB) consultation resources were established by the Utah Trial Innovation Center to assist and educate investigative teams prior to the submission of funding applications for multisite, cooperative research. Qualitative analysis of the written consultation materials and meeting minutes revealed the most common areas of education needed by investigative teams, including (a) the differences and relationships between the IRB and a Human Research Protection Program (HRPP); (b) the main phases of the SIRB process; and (c) the use of technology platforms for documentation of SIRB review processes. For investigative teams who are inexperienced with using a SIRB, such consultation in the pre-award period is likely to fill in knowledge gaps and improve the study start-up process.

Background: High-quality primary care needs to be person-centred, and GPs must communicate effectively to ensure continuity and coordination of care. In Kenya, there is little knowledge about the quality of communication in consultations by GPs. Aim: To evaluate the quality of communication in consultations by GPs. Design & setting: Descriptive, observational study of 23 GP consultations in 13 private sector primary care facilities in Nairobi, Kenya. Method: One consultation with a randomly selected adult patient was recorded per GP, and 16 communication skills evaluated with the Stellenbosch University Observation Tool (SUOT). A total percentage score was calculated per consultation, and compared with the GPs’ demographics and the consultation complexity and duration using the Statistical Package for Social Sciences (SPSS, version 25). Results: The GPs’ median age was 30.0 years (interquartile range [IQR] 29.0–32.0) and median consultation time was 7.0 minutes (IQR 3.0–9.0). Median overall score was 64.3% (IQR 48.4–75.7). GPs demonstrated skills in gathering information, making and explaining the diagnosis, and suggesting appropriate management. GPs did not make an appropriate introduction, explore the context or patients‘ perspectives, allow shared decision making, or provide adequate safety netting. There was a positive correlation between the scores and duration of the consultations (r = 0.680; P = 0.001). The score was higher in consultations of moderate complexity (78.1, IQR 57.1–86.7) versus low complexity (52.2, IQR 45.1–66.6) (P = 0.012). Conclusion: Consultations were brief and biomedical by young GPs. GPs need further training in communication skills, particularly with regard to delivering person-centred consultations. Deploying family physicians to the primary care setting would also improve the overall quality of service delivery.

Objective: The objective of this study was to evaluate the changes in the attitude of dentists in Cambodia towards the pandemic and understand the newer measures implemented to restrict the spread of the SARS-CoV-2 infection. Methods: A structured self-administered questionnaire was developed at the University of Puthisastra, Phnom Penh and provided to the participants for data collection. The questionnaire was developed using Google survey to collect demographic data followed by information regarding the working conditions, newly implemented measures during the pandemic and the attitude of Cambodian dentists towards the threat of infections. Results: Out of a total of 130 dentists that were asked to fill up the online questionnaire a total of 103 Cambodian dentists responded which resulted in a response rate of 79.2%. 93.1% dentists felt that the current situation was risky in terms of infections and were unsure of when the situation would be normal. In terms of measures implemented almost 88.3% dentists had employed newer measures to control the spread of infections while 26.2% dentists were utilizing online and telephonic consultations for patient consultations and screening before their visits to the clinic. Conclusion: From the findings of this study, we can see that Cambodian dentists are well aware and have adequate knowledge regarding the COVID-19 pandemic and have employed measures to ensure that there is no spread of infection in a dental setting. [ABSTRACT FROM AUTHOR]