Health Education and the primary care physician: the practitioner's perspective

Considering the attention given to health education and promotion, it is surprising that little research assesses the opinions and behavioral inclinations of physicians. Survey data collected in Florida address this issue. Responses of primary care private practitioners reveal that whereas MDs endorse health promotion and acknowledge a link between positive lifestyle and health, their outlook regarding the potential of community-based health education remains skeptical. A majority blame ineffective health education on public apathy. Nonetheless, a sizeable minority are willing to either begin or increase their involvement in health education programs. Multivariate analyses suggest that active or receptive MDs view the public's lifestyle knowledge as inadequate and select the MD as the health professional most suited to assume primary responsibility for health education. Clues for identifying practitioners who might engage in further health education are provided by examining age, specialty, patient load and community size. For example, GPs/FPs might more readily endorse an educational program if it allows for one-to-one physician-patient interaction; emphasizing this instructional mode appears less important in securing the cooperation of their more specialized primary care counterparts. Further, MDs with the larger caseloads are more likely to view health education as the physician's responsibility.     

Palliative care: a perspective of comprehensive care for the cancer patient

The purpose of this article is to ponder on the relevance of palliative care in assisting ill patients with neoplasias in their dwellings, since palliative care aims at giving patients and their families the best attainable quality of life. Despite the great emphasis placed upon this type of care being aimed at terminal patients, many of its principles are also applicable to initial stages of the disease, used in combination with the therapeutic measures required by the specific pathologic process. Thus, throughout this article, I outline some aspects concerning ethics, philosophy, and assistance which have guided this therapeutic modality from its start until today.     

Competencies for health management practice: a practitioner's perspective

The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.     

Management of the patient with a total joint replacement: the primary care practitioner's role

The primary care practitioner assumes chief responsibility for patients with arthritis. More than 40 million Americans experience some form of arthritis. Management of the patient with arthritis may include a referral to an orthopedic surgeon for surgical intervention. As estimated, up to 500,000 total joint replacement procedures are performed by orthopedic surgeons each year in the United States. Presurgical evaluation for a total joint replacement is imperative to ensure that the patient can safely undergo this surgical procedure. Postsurgical care of a patient with total joint replacement involves coordinating care with the physical therapist and orthopedic surgeon to ensure adequate follow-through with the recommended rehabilitation program, prophylactic antibiotic coverage, and observation for any complications including infection, deep-vein thrombosis, or loosening of the total-joint prosthesis.     

Family practitioner's and specialist's role in the care of the patient with epilepsy

Differences of opinion between GPs and medical specialists about their roles in the care of patients with epilepsy make it difficult to improve this care. To assess the roles of GP and specialist care a random sample of 500 GPs and all clinical neurologists in The Netherlands were sent a questionnaire about their attitude and actual behaviour towards tasks concerning epilepsy. The response was 54%. Non-response analysis did not bring forward statistically significant differences. Both GPs and specialists considered further diagnosis and starting antiepileptic drug regimens tasks for the specialist. The treatment of attacks in the patient's home situation was considered by both groups as a task for the GP. About other tasks opinions were that they ought to be shared or opinions appeared to be divided. According to the authors tasks about which consensus exists as well as tasks about which opinions differ should be considered carefully: on management level by the Epilepsy consultation group of the Dutch Society of General Practitioners and the Dutch Epilepsy Federation, on care level by introducing a patient information card.     

Health care from the perspective of a patient: theories for improvement

The future of health care will depend on the ability of providers to produce health services that satisfy the needs of all customers at prices they can afford. This implies both innovation and improvement of quality. Quality has to start with the provider. The patients do not know what they want, although they are fast learners and can judge what they have received. Patient feedback is important, but it is only a small part of the many facets of transformation needed in health care. Improvement involves prediction and prediction depends on theory. This article describes some theories for improvement based on a patient's hospital experience.     

Agreement between specialists' care and family practitioner's intention in patient referral]

The interaction between the general practitioner (GP) and the medical specialist during the referral process was studied in 309 referrals by GPs to medical specialists in eight hospitals in the north of the Netherlands, notably the extent of agreement between the specialist care and the intention of the GP. Furthermore the influence of two factors on the referral process was investigated: 'the clarity of the question in the referral letter' and 'the view of each other's professional tasks'. In most of the cases the GPs allowed the specialists a free hand. In the few cases the GP wanted a restricted consultation the specialist did more than the GP wanted him to do. In one of five referrals the GP or the specialist thought that the specialist had not done what the GP had asked. In most of these cases this impression was not confirmed by the objective evaluation by independent doctors. According to these the referral question was ambiguous. The GP's would like to have more influence on specialist care than the specialists were prepared to allow. The two factors each had an influence on several moments in the referral process. The main conclusion of the study is: the behaviour of the GP does not fit his attitude.     

Managing gastroesophageal reflux disease in primary care: the patient perspective

Gastroesophageal reflux disease (GERD) is a chronic disease that affects up to 20% of the population of Western countries and accounts for around 5% of a primary-care physician's workload. A better understanding of how GERD affects many aspects of patients' lives may aid the management of patients in primary care. We conducted a systematic review of the effect of GERD on health-related quality of life (HRQL) in the primary-care setting and in the community. Validated questionnaires have shown that GERD patients consulting in primary care experience substantial reductions in both physical and psychosocial aspects of HRQL, as well as work productivity. Impairments in HRQL are seen whether or not reflux esophagitis or Barrett's esophagus is present on endoscopy, and are comparable with or worse than those seen in patients with other chronic diseases such as heart disease, diabetes, and cancer. Surveys in primary care and in the community highlight disrupted sleep, reduced concentration at work, and interference with physical activities such as exercise, housework, and gardening. Psychosocial aspects of patient well-being are also impaired, including enjoyment of social gatherings, intimacy, sex, and many individuals with GERD remain worried about the underlying cause of their symptoms. In conclusion, many aspects of HRQL are impaired in GERD patients. The primary-care physician is uniquely placed to assess and address the impact of GERD on patients' lives.     

Conversation: the fundamental nursing care from the perspective of the hospitalized patient

The study focuses conversation as care that integrates other elements of hospital nursing. It had as its objective to analyze conversation as an essential stage of the dialogue between the patient and the nursing team. Five people participated who had already been hospitalized and that were now under clinical monitoring due to learning to live with AIDS. The information was obtained by means of the "Almanac" technique of sensitivity and creativity, semi-structured interview, and by active observation. The study contributed to reinforce the relational nature of the nursing care and the position of the patient as an object of this care who expresses his/her requests and wants in the process of dialoguing between this person and the nursing staff, expressed by conversation, which is viewed as a significant factor in nursing care.     

Building new hospitals: a UK infection control perspective

Infection control input is vital throughout the planning, design and building stages of a new hospital project, and must continue through the commissioning (and decommissioning) process, evaluation and putting the facility into full clinical service. Many hospitals continue to experience problems months or years after occupying the new premises; some of these could have been avoided by infection control involvement earlier in the project. The importance of infection control must be recognized by the chief executive of the hospital trust and project teams overseeing the development. Clinical user groups and contractors must also be made aware of infection control issues. It is vital that good working relationships are built up between the infection control team (ICT) and all these parties. ICTs need the authority to influence the process. This may require their specific recognition by the Private Finance Initiative National Unit, the Department of Health or other relevant authorities. ICTs need training in how to read design plans, how to write effective specifications, and in other areas with which they may be unfamiliar. The importance of documentation and record keeping is paramount. External or independent validation of processes should be available, particularly in commissioning processes. Building design in relation to infection control needs stricter national regulations, allowing ICTs to focus on more local usage issues. Further research is needed to provide evidence regarding the relationship between building design and the prevalence of infection.     

口腔器械灭菌与控制医院内感染

医院感染是指在医院获得的感染。1978年世界卫生组织对医院感染的定义为：凡是患者因住院、陪诊(护)或医院工作人员因医疗、护理工作而被感染所引起的任何临床显示症状的微生物性疾病．无论受害对象在医院期间是否出现症状,均属于医院感染。发生医院感染,对医者来说直接影响医疗质量;对患者来讲,可进一步造成其身体伤害,甚至死亡,且大大增加了医疗费用。早在19世纪,俄国外科医生皮果罗夫就曾经说过：“根据多年的实践经验可以大胆断定,大部分患者不是由于损伤本身,而