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Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the Roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the Roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the Roadmap as the building blocks and style of consultation become more familiar. Keywords: Psychologically Informed Practice, Pain, Communication, Introduction A detailed description of psychologically informed practice (PiP) and its origins (1) is presented in the accompanying paper in this issue. (2) In brief, PiP's most distinctive features are [...]

2022 OCT 15 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Fungal Diseases and Conditions - Candida is now [...]

The cost of caring for patients with heart failure (HF) creates an economic burden for care providers. Structured telephonic consultation between nurses and patients with HF within 48 hours after hospital discharge to review self-care instructions and health maintenance and promotion activities is a simple yet effective intervention to decrease 30-day readmission rates., Since 2012, the Affordable Care Act Hospital Readmissions Reduction Program has restricted hospital and provider reimbursements for patients with certain chronic conditions (heart failure [HF], diabetes, asthma, chronic obstructive pulmonary [...]

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation namely, the evincing and sharing of ethical opinion about a case--but also enables consultants to improve their practice and to pursue research on clinical ethics consultation.

Background Black and Hispanic women with early-stage breast cancer are more likely than white women to experience fragmented care and less likely to see medical oncologists to get effective adjuvant treatment. We implemented a tracking and feedback registry to close the referral loop between surgeons and oncologists. Methods We compared completed oncology consultations and use of adjuvant treatment among a group of 639 women with newly diagnosed stage I or II breast cancer who had undergone surgery at one of six New York City hospitals from 1999 to 2000 with the same outcomes for a different group of 300 women with breast cancer whose surgeries occurred in 2004-2006, after the implementation of the tracking registry. Underuse of adjuvant treatment was defined as no radiotherapy after breast-conserving surgery, no chemotherapy for estrogen receptor (ER)--negative tumors, or no hormonal therapy for ER-positive tumors 1 cm or larger. We used hierarchical modeling to adjust for clustering within hospital and surgeon practice. Odds ratios were converted to adjusted relative risks (aRRs). All statistical tests were two-sided. Results Implementation of the tracking and feedback registry was accompanied by a statistically significant increase in oncology consultations (83% before vs 97% after the intervention; difference = 14%; 95% confidence interval [CI] = 11% to 18%; P < .001) and decrease in underuse of adjuvant treatment (23% before vs 14% after the intervention; difference = -9%, 95% CI = -12% to -6%; P < .001). Underuse declined from 34% to 14% among black women, from 23% to 13% among Hispanic women, and from 17% to 14% among white women (chi-square of change in underuse from before to after among the three racial groups; P = .001). In multivariable models adjusting for clustering by hospital and surgeon, the intervention was associated with increased rates of oncology consultation (aRR = 1.6, 95% CI = 1.3 to 1.8), and reduced underuse of adjuvant treatment (aRR = 0.75, 95% CI = 0.6 to 0.9). Compared with the preintervention findings, minority race was no longer a risk factor for low rates of oncology consultation (aRR = 1.0, 95% CI = 0.7 to 1.3) or for underuse of adjuvant therapy (aRR = 1.0, 95% CI = 0.8 to 1.3). Conclusions A tracking and feedback registry that enhances completed oncology consultations between surgeons and oncologists also appears to reduce rates of adjuvant treatment underuse and to eliminate the racial disparity in treatment.

Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and questions about patient autonomy. In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan's first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received. Over approximately 15 months (October 2006-December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes.

Physician-patient interactions are key relationships which are the subject of many complaints by patients in the US. Many Americans complain that their doctors do not listen. Patients, however, can get the most out of a medical consultation through seven suggested methods.

Earlier this morning I found the time to glance through the latest issue of the British Medical Journal. It's somewhat ironic to say that 'I found the time to glance [...]

New proposals to open up prescribing of scheduled medicines to registered nurses are now open for public consultation. The Nursing and Midwifery Board of Australia (NMBA) has invited feedback on [...]

'Fundamental' changes to the GMC convince DoH that new super-regulator is unnecessary expense. A key plank of reforms to the GMC prompted by the Shipman inquiry could be scrapped, the [...]

In this series on consulting skills, Dr Peter Tate discusses common scenarios you can watch online. This week's scenario concerns a common outcome of the cervical screening programme. Most women [...]

Talking straight with your doc Trying to describe symptoms to your physician can be excruciating, but you need to meet the doctor halfway. Cough up some details using our expert [...]

Byline: Roberson, Laura [employee] My illegal heart : 5 stay-safe rules for the desperate patient If conventional medicine fails, use these guidelines to find an alternative--whether it's an off shore [...]

It may sound obvious, but write notes as soon as possible after seeing a patient. Otherwise, things quickly become forgotten or muddled between patients with similar problems. - All consultations [...]

A study was conducted to evaluate the aspects which cancer specialists in Australia perceived as difficult in consulting and communicating with patients suffering from cancer and their families. Results indicated that doctors usually found the most difficult task to be explaining the high cost of medicines and treatment failure to patients and families.

Social workers can be forgiven for being a tad cynical about consultation exercises. Every month another one begins, as drenched in high ideals as they are divorced from the realities [...]

A study was conducted to measure the independent effect on length of general-practice consultations of a range of characteristics of the general practitioner (GP), practice, patient and consultation. Results suggest that the independent relationship of some GP, practice, patient and consultation characteristics with length of consultation might affect future GP supply.

The average length of GP consultations in the UK is nine and a half minutes, according to European research but this varies with workload. A study of six countries found [...]

A visit to the doctor is a time to talk and learn, and, just like doctors, nurses, and other caregivers, patients play a critical role in their healthcare, according to [...]

One sees no fewer than four patients an hour, and often it's six or seven. Her Internet paging system buzzes to let her know in which room to find her [...]

Almost every Wednesday morning at 9:30, Geoff Bedford drops into his doctor's office in Fraser Lake, British Columbia--along with a dozen other patients--for a group checkup. Everyone watches as Bedford's [...]