综合医院精神科联络会诊分析

目的探讨综合医院各临床科室请精神科联络会诊的特点。方法收集2007年7月～2008年8月共计14个月的会诊病例,通过会诊邀请单及自编的会诊情况问卷收集资料。采用SPSS12．0进行统计。结果邀请会诊年龄在5～97岁,平均（52±21）岁,男性占50％以上;按会诊分配比例由高到低的科室为神经内科、骨科、脑外科、老年病科、消化科、心内科等。结论精神科联络会诊在各年龄段均有,以中老年为主;申请科室中除神内、脑外以外,骨科和老年病科也较多;年转入率减低,而精神科药物使用在各科室逐渐增多。生物-心理-社会医学模式渐入人心。     

对住院麻风患者开展足底溃疡咨询服务的近期效果研究

目的探索对麻风住院患者开展足底溃疡咨询服务的近期效果,为在麻风村推广足底溃疡咨询服务提供依据。方法自行设计咨询服务指南,对47例住院麻风患者进行咨询服务。采用麻风足底溃疡相关知识、行为养成问卷及麻风继发性残疾分数,对近期疗效进行测评。结果47例患者的麻风足底溃疡相关知识水平明显提高,知晓须带水上油知识的比例由38．30％上升到76．60％;相关行为有了较大程度改善,限制行走者由44．68％上升至80．85％;继发性残疾分数中皲裂及溃疡分数下降,骨缺失分数无变化。结论咨询服务对改善麻风足底溃疡患者的近期效果较好。     

临床药师参与会诊 对少见病原生物感染案例的分析

临床药师对参与的3例少见病原生物(超鞭毛虫、解没食子酸链球菌、希木龙假丝酵母菌)感染临床案例会诊,根据病原特点、患者疾病情况及抗感染药物的药理作用,协助临床调整个体化给药方案,取得积极效果.     

Validation of the ComCare index for rater-based assessment of medical communication and interpersonal skills

ObjectivesTo develop and validate a short instrument to assess undergraduate medical students’ communication and interpersonal skills in videographed history taking situations with simulated patients.MethodsSixty-seven undergraduate medical students participating in an assessment including videographed physician-patient encounters for history taking with five simulated patients were included in this study. The last video of each participant’s consultation hour was rated by two independent assessors with the eight-item ComCare index for assessment of communication and interpersonal skills newly designed for the external rater perspective (ComCareR). We compared the sum scores of the ComCareR with ratings of the same videos with the Kalamazoo Communication Skills Assessment Form from an observational perspective (KCSAFd-video) and the Global Rating scale (GR), which also measure communication and interpersonal skills.ResultsThe ComCareR showed an excellent interrater reliability (ICC = .85). We found a small but significant correlation with the KCSAFd-video Interpersonal Competence (ρ = .34, 95% CI [.10,.54]) and a high positive correlation with the GR (ρ = .59, 95% CI [.40,.73]).ConclusionsThe ComCareR is a valid and brief index for holistic assessment of communication and interpersonal skills in physician-patient encounters.Practice implicationsThe ComCareR can be used for quick rater-based assessment of physicians’ communication and interpersonal skills.     

Does the structure of the medical consultation align with an educational model of clinical communication? A study of physicians’ consultations from a postgraduate examination

ObjectiveThis study examined whether the structure of consultations in which physicians were tasked with sharing information corresponded to the chronological stages proposed by an established educational model of clinical communication.MethodSeventy six simulated consultations from a postgraduate examination for general medical hospital physicians were transcribed verbatim and converted into diagrams showing consultation structure. All doctor-patient/relative talk was allocated into six phases: Initiating, Gathering information, Summary, Explanation, Planning and Closing, using the ‘communication process skills’ from the Calgary-Cambridge Guide to the Medical Interview.ResultsThe majority of consultations included four or five of the expected phases, with most talk (41–92%) in Explanation and Planning. There was no discernible consistency of structure across the consultations or in consultations from the same scenario. Consultations varied in the presence, sequential order, size, location and reappearance of phases.ConclusionsThe structure of consultations in this standardised setting bore little resemblance to the chronological order of phases predicted by an educational model.Practice implicationsEducational guidance and interventions to support patients in preparing for consultations need to take account of doctors’ behaviour in practice. Assumptions about the organisation of medical consultations should be queried in the absence of an evidence base.     

Patient feedback questionnaires to enhance consultation skills of healthcare professionals: A systematic review

Objective

To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners.