Interest of a specific programme in patient education for dialysis in out-center patients

The development of therapeutic patient education for dialysis patients is recent and concerns mainly out-center patients. To our knowledge, only two papers centred on therapeutic education with out-center patients have been published. The particularities of this dialysis modality (unit close to the home, more autonomy, a nurse for six patients, organisation of unit, better quality of life and psychological status) highlight the interest to develop specific educational programs for patients treated in out-center sitting. The example of a program in Aquitaine (France) composed of mainly collective sessions (representations of the disease, dietetic recommendations, hygiene and protection of the vascular access, drugs compliance…) allows to propose several practical implications to initiate the development of specific programs in therapeutic education for out-center dialysis: educative sessions during the sessions of dialysis, group patients, multidisciplinary team, evaluation of the program from a medical and psychosocial point of view…     

Internet rounds: a congenital heart surgeon's Web log

As the complexity of congenital heart care increases, and expectations for improved outcomes grow, the limitations of current medical information management systems are exposed. Despite advances in information management technology, achieving a state of information resonance within a congenital heart team, where comprehensive patient data and real time program performance can be intuitively accessed on demand, remains an elusive goal. The World Wide Web constitutes a potential platform for a medical information management system capable of overcoming the limitations of traditional medical information exchange. We designed and implemented an Internet based information management system to collect, store and exchange comprehensive patient information, and measure clinical performance in real time. Use of this system has been associated with improved clinical outcomes for a congenital heart team.     

The medical responsibility: current view from the Council of Physicians side

The medical responsibility has been clearly defined in the Royal Decree no. 78 dated November 11, 1967 concerning the medical practice. Moreover, several articles from the Ethical Code (Code de Déontologie) have clarified some social and economical responsibilities in the medical practice (articles 99 to 103) and the quality of patient care (article 36). The National Council has also published at least 31 advises facing the daily reality and the growing insecurity. That atmosphere is coming from the jurisprudence, the increasing responsibility insurance fees, the obligation of results instead of means, and the project of patient rights law. That project is currently dissociated from other projects such as an update on the medical responsibility and/or the no fault indemnity. Therefore, there is a current need for developing written patient information and using informed consent forms for risky surgical procedures. Before recognizing the no fault concept with indemnity, it is necessary to review the coverage of the responsibility insurance, educate the medical doctors in the no fault concept, study the mode of compensation for therapeutic hazards and differentiate the objective and subjective parts of the patient's chart.     

Protocol for ureteroscopy in the diagnosis and treatment of the upper urinary tract transitional cell carcinoma

Since Pérez-Castro and Martínez-Pi?eiro initiated diagnostic and therapeutic ureteroscopy this technique has gained a place in the management of upper urinary tract tumors. Improvement of the equipment (rigid and flexible), better diagnosis and knowledge of outcomes and allows to treat a group of patients with transitional cell carcinoma of the ureter and pelvis by the conservative retrograde technique. In this article, we present an overview of indications and management of the upper urinary tract tumor by ureteroscopy.     

Use of computer-assisted learning module to achieve ACGME competencies in orthopaedic foot and ankle surgery

The Accreditation Council for Graduate Medical Education (ACGME) has charged academic institutions with finding methods to assess learning in specific areas of resident education. Computer-assisted education offers a reliable mode for teaching residents important information and skills. The CD-ROM "Fundamentals of Orthopaedic Foot Care," produced by the American Academy of Orthopaedic Surgeons, was tested as a tool to provide nonoperative foot and ankle care education for a group of orthopaedic residents (N = 14) and a group of family practice residents (N = 11). The CD-ROM's educational format includes an interactive tutorial on anatomy, video demonstrations on selected topics in physical examination and basic treatment of nonoperative problems of the foot and ankle, and patient education information sheets on multiple common foot disorders. Both resident groups scored significantly higher on their post-test exams after spending 1 hour with the computer program (p < or = .05). This study suggests that this program can be used reliably in an orthopaedic residency program to achieve ACGME required competency of "medical knowledge" in evaluation and nonoperative management of common foot and ankle problems.     

European Association of Urology (@Uroweb) Recommendations on the Appropriate Use of Social Media

Social media use is becoming common in medical practice. Although primarily used in this context to connect physicians, social media allows users share information, to create an online profile, to learn and keep knowledge up to date, to facilitate virtual attendance at medical conferences, and to measure impact within a field. However, shared content should be considered permanent and beyond the control of its author, and typical boundaries, such as the patient–physician interaction, become blurred, putting both parties at risk. The European Association of Urology brought together a committee of stakeholders to create guidance on the good practice and standards of use of social media. These encompass guidance about defining an online profile; managing accounts; protecting the reputations of yourself and your organization; protecting patient confidentiality; and creating honest, responsible content that reflects your standing as a physician and your membership within this profession.     

Steigerung von Effizienz und Patientenzufriedenheit durch strukturierte Prozesse am Beispiel der Pr?medikationsambulanz

Background

In clinical routine the process of presurgical visit and signed informed consent is imperfectly realized in surgical patients.

Material and methods

A total of 450 consecutive patients were interviewed after a presurgical visit for informed consent using a questionnaire. The aim of the study was to investigate the amount of knowledge gained by informed consent. Patient satisfaction with medical treatment and logistic workflow was correlated with real waiting times and process times.

Results

Mean information duration was 36.1±0.8?min. In patients with no appointed time, waiting times and overall stay was shorter. Patient??s satisfaction with medical treatment and time process was significantly higher in the elderly. Longer conversation with the surgeon was associated with a higher assessment of surgeons?? medical experience irrespective of his specialist??s state. Real waiting times did not affect patient??s satisfaction.

Conclusion

A walk-in clinic for presurgical visit and signed informed consent can improve patient satisfaction. It allows an excellent patients information in an appropriate time-frame. Clinical pathways can improve patient satisfaction and information concerning the lining up operation and disease pattern.     

Evidence and experience: what is the balance in surgeons' training?

Surgeons' training requires professionalism, continuing medical education, and appropriate environment to ensure the desirable success. However, generally, this goal is pursued in an inefficient way, based upon intensive training skills founded in the age-old philosophy of "the way I have learned it". There is, usually, a lack of patient outcome evaluation, especially of long-term follow-up of surgical procedures, which in turns provide little evidence of senior surgeons for adequate training junior surgeons. On the other hand, questioning the established knowledge is not stimulated, or even not tolerated by the seniors. It seems like the "truth" is absolute and allows no change for the new knowledge, which would mean no additional progress. There is a need to significantly alter the implementation of new knowledge, if possible based on evidence, to ensure the best medical care for the surgical patient. Experimental surgery, and nowadays bench model surgery, may be useful in minimizing the predictable complications of patients under the surgeon training responsibility, while on learning curve. Surgery based on evidence should be one of the tools for improving patient surgical care, since this important branch of medical activity must rest on two pillars "art and science"; and surgeon in good training needs to be close to both.     

Patient education on the internet: opportunities and pitfalls

The Internet, an increasingly pervasive part of our culture, has vastly increased the rate at which information is disseminated. Unfortunately, a substantial portion of medical information on the Internet is false or misleading. Realizing this, many patients would like their physicians to help guide their online searches for medical information, but most physicians do not feel comfortable enough with the Internet to provide this service. A recent poll by Cyberdialogue (2000) found that 70% of all patients would like their physicians to recommend a health care web site for their condition, but that only 4% of patients receive such a recommendation. In recommending medical web sites, physicians need to consider the quality of the web site, the quality of the content, and especially the ethics of the site. The most important ethical standard a web site must meet is the clear separation of its editorial comment from promotional material. Patients do not have enough knowledge to distinguish unbiased information from information designed to push a product or service. There are organizations such as the Health on the Net Foundation and the E-Health Code of Ethics that have established clear quality and ethical criteria, but very few resources exist for these organizations to use in policing the sites that claim to adhere to their criteria. The National Institutes of Health recently started a consumer web site (www.medlineplus.gov) that takes web sites that adhere to their stringent criteria and places them on their web site, thus ensuring proper compliance. Patient education from sources other than face-to-face contact with a physician should be seen as an adjunct to the medical practice of physicians, and not as competition. Information is a form of therapy, and should lead to better referrals, more realistic outcome expectations, better treatment compliance, and better outcomes. As long as patients are referred to information that is unbiased, well-written, and not proprietary, their decision making should be enhanced, bringing them into the decision-making loop. This allows the patient to be much more involved with his or her care. As the medical profession changes from a "gatekeeper" model to a patient choice model, patient education will take on a much greater role.     

Training surgeons to do evidence-based surgery: a collaborative approach

BACKGROUND: Three of the Accreditation Council for Graduate Medical Education general competencies contain specific wording indicating that trainees must learn how to locate, appraise, and integrate the best information from the literature into their patient care practices. What is less clear is how to best translate evidence-based concepts into the workday of the resident, fellow, or attending surgeon. In this article we describe our use of the assignment-based training program we developed to ensure that our trainees can actually do what is required to practice evidence-based operations. STUDY DESIGN: Our collaborative program draws on the expertise of an attending surgeon, a medical librarian, and a research coordinator. The curriculum is designed so that all residents in our program develop and refine their evidence-based surgery skills in a context relating to their clinical practice. They are given a practice-related clinical question and are asked to demonstrate their competence in finding the best available evidence to answer it. This involves restating the question as a well-formulated clinical question, doing a focused literature search, critically appraising the results to find the best evidence, and integrating the information into practice, if appropriate. Search assignments are evaluated using a structured form and additional training is designed based on the results. Another question is then assigned to assess improvement. RESULTS: Residents' performance on a first assignment showed specific weaknesses in use of textwords and limiters. Performance was strongly related to a resident's ability to obtain the best evidence in answer to a clinical question (p = 0.011). Substantial improvement was shown on a second assignment after additional training. CONCLUSIONS: Our hands-on, performance-based program allows us to document trainees' progress in developing skills that will allow them to efficiently locate the best evidence available to inform their patient care decisions.     

Anaesthesiologists' views on the need for point-of-care information system in the operating room: a survey of the European Society of Anaesthesiologists

BACKGROUND AND OBJECTIVE: In this preliminary study we wanted to explore the attitudes of anaesthesiologists to a point-of-care information system in the operating room. The study was conducted as a preliminary step in the process of developing such a system by the European Society of Anaesthesiologists (ESA). METHODS: A questionnaire was distributed to all 2240 attendees of the ESA's annual meeting in Gothenburg, Sweden, which took place in April 2001. RESULTS: Of the 329 responders (response rate of 14.6%), 79% were qualified specialists with more than 10 yr of experience (68%), mostly from Western Europe. Most responders admitted to regularly experiencing lack of medical knowledge relating to real-time patient care at least once a month (74%) or at least once a week (46%), and 39% admitted to having made errors during anaesthesia due to lack of medical information that can be otherwise found in a handbook. The choice ofa less optimal but more familiar approach to patient management due to lack of knowledge was reported by 37%. Eighty-eight percent of responders believe that having a point-of-care information system for the anaesthesiologists in the operating room is either important or very important. CONCLUSIONS: This preliminary survey demonstrates that lack of knowledge of anaesthesiologists may be a significant source of medical errors in the operating room, and suggests that a point-of-care information system for the anaesthesiologist may be of value.     

A microcomputer system for the practising cardiac surgeon

The authors present a computer program designed for the practising cardiac surgeon who wishes to computerize patient data. The program is efficient, versatile and can be adapted to individual needs. It can be used with any IBM PC-compatible machine and requires little knowledge of computer science. More than 250 items on 30 000 patients can be stored and all this information analysed simultaneously. The program can chart a patient's profile and tabulate the information of the entire registry. It can generate lists of patients with their surgeons, cardiologists, diagnoses, operations and dates of intervention. It can also be used for mailing purposes.     

门急诊护理信息化管理对患者就医满意度的影响

目的加强门急诊护理信息化环节管理,提高患者门诊服务满意度。方法建立网络平台方便患者预约挂号和预约诊疗,实行自助缴费、自助打印检查报告,整合护士分诊台,护士实施走动式健康教育。结果改进后患者挂号爽约率减少,对门诊服务满意度显著提升,有效投诉率显著下降(均P<0.01)。结论加强门急诊信息化系统管理可不断完善就医流程和体验,满足患者就医需求,提高满意度。     

Postgraduate education in surgery]

During the past 100 years, specialization and differentiation in medicine have developed rapidly. As a field of culture, medical science has progressively been deprived of the philosophical and ethical elements that are the most important part of the practice of medicine. New technology has improved surgical techniques for curing diseases but often the patient as a whole human being has been lost sight. Before imparting super-specialized knowledge and techniques to postgraduate medical students, a global standard of primary care, understanding, and sympathy for the patient must be provided. No super-specialty that does not also fulfill the minimum requirements for general, fundamental medical and surgical knowledge and techniques will be accepted and respected by the majority of people. So-called straight residency training in super-specialties starting immediately after medical school must cease. A residency program of several years including primary-care training for general surgery is mandatory to educate well-balanced "surgical specialists." Such a curriculum must be developed and constantly revised in response to social needs.     

Medical and Lay Information about Obesity Surgery

Reluctance or open opposition to new surgical techniques or surgical approaches are common both with medical and non-medical groups, and they are mainly due to lack of proper knowledge of the possibilities and limitations of these procedures. In Mexico, there is a lag between medical and surgical progress and the medical and lay information about them. The purpose of this study was to assess the magnitude of this situation. The 238 physicians interviewed comprised 137 internists and 101 surgeons. 787 patients were also interviewed; all of them were asked about obesity surgery, information on medical and non-medical publications, advice about obesity surgery in a special case or patient, and type of surgery performed. Among the physicians, none of the internists would advise obesity surgery to any patient, and most of them only recall intestinal bypass as the current procedure for obesity; only 3% had read about obesity surgery. Surgeons, on the contrary, had more precise information about surgery, 25% had read about techniques and results, and 20% would advise surgery for their patients. The general population had a very vague idea of obesity surgery, with confusion between liposuction and intestinal surgery; most of the individuals interviewed had magic or miraculous conceptions about surgeons and their ‘powers’ to eliminate fat. It is concluded that medical and non-medical groups lack the adequate knowledge and comprehension of obesity surgical procedures, and this is one of the problems obesity surgeons face in everyday practice.     

La place du patient dans la médecine factuelle

Medical practice has undergone a significant evolution over the last decade due to two important factors: (1) the theory and practice of Evidence-Based Medicine (EBM) has become widely established; (2) the relationship between health-care professionals and patients or clients has been profoundly modified. In this review, we discuss the heterogeneity and variability of patient preference and the need to develop a doctor–patient relationship, which facilitates shared decision-making in preference to previous models based on patient information without choice and paternalistic attitudes. Thus, this modern concept of care based on EBM shifts the focus of interest from the disease entity itself to that of the patient suffering from a disease. The patient has a right to information concerning his illness; this information helps the patient to participate in medical decisions through the laying out of clinical practice guidelines. These aspects of the patient's role in care management are illustrated by a national program in the field of oncology which empower the patient in the decisions arrived at by a multi-disciplinary oncology team.     

Analysis of the concept of risk in a medical teaching program

The concept of risk has acquired an extremely important place in medical care in the course of various social developments. This concept plays a role in the physician-patient relationship, especially as the form in which the physician provides information to the patient; it is also a form of medical knowledge. We propose a cross-sectional medical course module on this concept of risk, intended for medical students; it can be included in module 1 of the curriculum for the national ranking examination. This class enables a new approach to medical care by showing the variety of definitions of risk and facilitating their perception and integration. Through a process that is simultaneously epistemological and practical, it aims to associate the medical knowledge we use every day with the concept of risk and thereby help the students take a critical distance relative to the mass of available knowledge. This approach to medical knowledge through the concept of risk makes the knowledge more operational and more pertinent within the context of individual clinical situations and thus optimizes medical care. Its pedagogical techniques combine standard classroom lectures with workshops involving role-playing in specific scenarios. This original course meets the needs of medical students who are in the process of becoming health care providers--needs related to the analysis and use of available medical knowledge in their clinical practice and to some aspects of the patient-provider relationship.