Does primary medical practitioner involvement with a specialist team improve patient outcomes? A systematic review.

Patients with chronic or complex medical or psychiatric conditions are treated by many practitioners, including general practitioners (GPs). Formal liaison between primary and specialist is often assumed to offer benefits to patients The aim of this study was to assess the efficacy of formal liaison of GPs with specialist service providers on patient health outcomes, by conducting a systematic review of the published literature in MEDLINE, EMBASE, PsychINFO, CINAHL and Cochrane Library databases using the following search terms family physicians': synonyms of 'patient care planning', 'patient discharge' and 'patient care team'; and synonyms of 'randomised controlled trials'. Seven studies were identified, involving 963 subjects and 899 controls. most health outcomes were unchanged, although some physical and functional health outcomes were improved by formal liaison between GPs and specialist services, particularly among chronic mental illness patients. Some health outcomes worsened during the intervention. Patient retention rates within treatment programmes improved with GP involvement, as did patient satisfaction. Doctor (GP and specialist) behaviour changed, with reports of more rational use of resources and diagnostic tests, improved clinical skills, more frequent use of appropriate treatment strategies, and more frequent clinical behaviours designed to detect disease complications Cost effectiveness could not be determined. In conclusion, formal liaison between GPs and specialist services leaves most physical health outcomes unchanged, but improves functional outcomes in chronically mentally ill patients. It may confer modest long-term health benefits through improvements in patient concordance with treatment programmes and more effective clinical practice.

Health education: the role and functions of the specialist and the generalist

Education for health is a process in which all public health and medical care personnel are involved. People learn both formally (planned learning experiences) and informally (unplanned learning experiences). Since the patient, the client, the consummer and the community expect public health and medical care personnel to assist them with health and disease issues and problems, the response of the professional "educates" the customer whether the professional intends to educate or not. Therefore, it is incumbent on all public health and medical care professionals to understand their educational functions and their role in health education. It is also important that the role of the specialist in education be clear. The specialist, as to all other specialists, has an in-depth knowledge of his area of expertise, i.e., the teaching/learning process; s/he may function as a consultant to others to enhance the educational potential of their role or s/he may work with a team or with communities or groups of patients. Specific competencies and knowledge are required of the health education specialist; and there is a body of learning and social change theory which provides a frame of reference for planning, implementing and evaluating educational programs. Working with others to enhance their potential to learn and to make informed decisions about health/disease issues is the hallmark of the health education specialist.

Intra-hospital organ and tissue donation coordination project: cost-effectiveness and social benefits

OBJECTIVE To evaluate the viability of a professional specialist in intra-hospital committees of organ and tissue donation for transplantation. METHODS Epidemiological, retrospective and cross-sectional study (2003-2011 and 2008-2012), which was performed using organ donation for transplants data in the state of Sao Paulo, Southeastern Brazil. Nine hospitals were evaluated (hospitals 1 to 9). Logistic regression was used to evaluate the differences in the number of brain death referrals and actual donors (dependent variables) after the professional specialist started work (independent variable) at the intra-hospital committee of organ and tissue donation for transplantation. To evaluate the hospital invoicing, the hourly wage of the doctor and registered nurse, according to the legislation of the Consolidation of Labor Laws, were calculated, as were the investment return and the time elapsed to do so. RESULTS Following the nursing specialist commencement on the committee, brain death referrals and the number of actual donors increased at hospital 2 (4.17 and 1.52, respectively). At hospital 7, the number of actual donors also increased from 0.005 to 1.54. In addition, after the nurse started working, hospital revenues increased by 190.0% (ranging 40.0% to 1.955%). The monthly cost for the nurse working 20 hours was US$397.97 while the doctor would cost US$3,526.67. The return on investment was 275% over the short term (0.36 years). CONCLUSIONS This paper showed that including a professional specialist in intra-hospital committees for organ and tissue donation for transplantation proved to be cost-effective. Further economic research in the area could contribute to the efficient public policy implementation of this organ and tissue harvesting model.

Interactional strategies between terminologist and domain specialist. Putting order into our universe: the concept of Blended Learning

A presente comunicação visa discutir as mais-valias de um desenho metodológico sustentado numa abordagem conceptual da Terminologia aplicado ao exercício de harmonização da definição do cenário educativo mais promissor do Ensino Superior actual: o blended learning. Sendo a Terminologia uma disciplina que se ocupa da representação, da descrição e da definição do conhecimento especializado através da língua a essência deste domínio do saber responde a uma necessidade fundamental da sociedade actual: putting order into our universe, nas palavras de Nuopponen (2011). No contexto descrito, os conceitos, enquanto elementos da estrutura do conhecimento (Sager, 1990) constituem um objecto de investigação de complexidade não despicienda, pois apesar do postulado de que a língua constitui uma ferramenta fundamental para descrever e organizar o conhecimento, o princípio isomórfico não pode ser tomado como adquirido. A abordagem conceptual em Terminologia propõe uma visão precisa do papel da língua no trabalho terminológico, sendo premissa basilar que não existe uma correspondência unívoca entre os elementos atomísticos do conhecimento e os elementos da expressão linguística. É pela razões enunciadas que as opções metodológicas circunscritas à análise do texto de especialidade serão consideradas imprecisas. Nesta reflexão perspectiva-se que o conceito-chave de uma abordagem conceptual do trabalho terminológico implica a combinação de um processo de elicitação do conhecimento tácito através de uma negociação discursiva orientada para o conceito e a análise de corpora textuais. Defende-se consequentemente que as estratégias de interacção entre terminólogo e especialista de domínio merecem atenção detalhada pelo facto de se reflectirem com expressividade na qualidade dos resultados obtidos. Na sequência do exposto, o modelo metodológico que propomos sustenta-se em três etapas que privilegiam um refinamento dessa interacção permitindo ao terminólogo afirmar-se como sujeito conceptualizador, decisor e interventor: (1) etapa exploratória do domínio-objecto de estudo; (2) etapa de análise onamasiológica de evidência textual e discursiva; (3) etapa de modelização e de validação de resultados. Defender-se-á a produtividade de uma sequência cíclica entre a análise textual e discursiva para fins onomasiológicos, a interacção colaborativa e a introspecção.

Estudo da actividade angiogénica na nurse cell de trichinella spiralis no decurso da triquinelose em modelo roedor

A triquinelose é uma zoonose parasitária que é transmitida aos humanos e animais, através da ingestão de carne crua ou insuficientemente cozinhada, que contenha larvas infectantes de Trichinella spp., sendo actualmente considerada uma doença emergente e/ou re-emergente. O sucesso do parasitismo do nemátode Trichinella spiralis está intimamente ligado com o processo de angiogénese, ou seja, a formação de novos vasos a partir de vasos pré-existentes. Com o objectivo de estudar a actividade angiogénica na nurse cell de T. spiralis, realizaram-se técnicas imunohistoquímicas e imunofluorescentes para o factor de crescimento endotelial vascular (VEGF), molécula-1 de adesão celular endotelial a plaquetas (PECAM-1) e actina músculo liso (AML), em tecido muscular de Rattus rattus infectado com T. spiralis. Através destas técnicas observou-se marcação intensa no infiltrado inflamatório adjacente à nurse cell e também na larva. Já o citoplasma da nurse cell apresentou uma marcação moderada. Este padrão de marcação manteve-se desde os 45 até aos 120 dias após a infecção. A avaliação da densidade vascular (PECAM-1) e da densidade da expressão de células positivas para AML permitiu estabelecer uma correlação positiva entre o aumento da densidade vascular e o número de dias de infecção. Adicionalmente estabeleceu-se uma correlação negativa entre o aumento da densidade de células que expressam AML e o número de dias de infecção. Os resultados indicam uma produção constante de VEGF pela larva, pelo citoplasma da nurse cell e pelo hospedeiro (infiltrado inflamatório), durante todo período de infecção, levando à formação de uma rede vascular crescente (com um aumento médio de 79% face ao controlo), acompanhada de células murais que promovem a sua estabilização (com um aumento médio de 50% face ao controlo) com particular incidência no primeiro período estudado (45 a 55 dias).

Balloniscus glaber (Crustacea, Isopoda, Balloniscidae), a habitat specialist species in a disturbed area of Brazil

ABSTRACT Balloniscus glaber Araujo & Zardo, 1995 (Balloniscidae), a Neotropical Oniscidea, has been recorded historically in environments with low or no human interference. In one of these areas, it was determined as aK-strategist. Recently, however, this species was documented in a disturbed forest within urban limits. The present work revealed that the population in the urban area has high density, high number of ovigerous females and mancae in the population, a long reproductive period, and early sexual maturity. These results suggest that modified environments may provide favorable conditions and that the species is not negatively affected by human influence.

Landscape context on generalist and specialist aphid natural enemies

Report for the scientific sojourn at the University of Lund, Sweden, between May and September 2007. A landscape-scale research approach has been highlighted by a growing body of literature as essential for understanding important ecosystem services as biological control. Aphids are victims of a diversity of enemies making the aphid-enemy interaction a nice example for the role of enemy diversity for the functioning of biological control. Here it is examined the effects of landscape complexity on cereal aphids and associated natural enemies that varied in the degree of specialization. Parasitoids wasps abundance did not differ between landscape types but was strongly negatively related to the percentage of arable land. In contrast, abundances of generalist predators like Coccinellidae were significantly higher in simple landscapes since can benefit from the high availability of a variety of alternative resources within cropping systems. Consequently coccinellidae-to-aphid ratio was significantly higher in fields in homogenous landscapes as compared to fields included in an heterogeneous landscape, suggesting that enemy pressure on cereal aphids increases with landscape simplification. The landscape effect will depend mainly on the degree of specialization of functionally dominant natural enemies, so that the results imply that conservation actions aiming to optimise abundance for one taxonomic group in the agricultural landscape will not automatically increase abundance of other groups. Given that the strength of natural enemy impact on biocontrol depends on landscape features and the role of functionally dominant natural enemies. So, therefore it is essential to focus the future empirical work in examining the schedule of agricultural landscapes that maintain a diversity of generalist and specialist natural enemies.

Older persons' perceptions of general practitioner or specialist primary care physicians : same point of view?

BACKGROUND: Identification of a Primary Care Physician (PCP) by older patients is considered as essential for the coordination of care, but the extent to which identified PCPs are general practitioners or specialists is unknown. This study described older patients' experiences with their PCP and tested the hypothesis of differences between patients who identify a specialist as their PCP (SP PCP) and those who turn to a general practitioner (GP PCP). METHODS: In 2012, a cross-sectional postal survey on care was conducted in the 68+ year old population of the canton of Vaud. Data was provided by 2,276 participants in the ongoing Lausanne cohort 65+ (Lc65+), a study of those born between 1934 and 1943, and by 998 persons from an additional sample drawn to include the population outside of Lausanne or born before 1934. RESULTS: Participants expressed favourable perceptions, at rates exceeding 75% for most items. However, only 38% to 51% responded positively for out-of-hours availability, easy access and at home visits, likelihood of prescribing expensive medication if needed, and doctors' awareness of over-the-counter drugs. 12.0% had an SP PCP, in 95.9% specialised in a discipline implying training in internal medicine. Bivariate and multivariate analyses did not result in significant differences between GP and SP PCPs regarding perceptions of accessibility/availability, doctor-patient relationship, information and continuity of care, prevention, spontaneous use of the emergency department or ambulatory care utilisation. CONCLUSIONS: Experiences of old patients were mostly positive despite some lack in reported hearing, memory testing, and colorectal cancer screening. We found no differences between GP and SP PCP groups.

Improving Patients' Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the HPSS in Northern Ireland (PDF 704 KB)

A Guide to Implementing Nurse and Pharmacist Independent Prescribing within the HPSS in Northern Ireland

Review of the Nurse Consultant Role - Northern Ireland (PDF 263 KB)

Review of the Nurse Consultant role undertaken by the Beeches Management Centre