Perceptions of psychological content in the GP consultation - the role of practice, personal and prescribing attributes

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

Effect of patient age on management decisions in breast cancer: consensus from a national consultation

This qualitative study investigated the attitudes, perceptions, and practices of breast cancer specialists with reference to the effect of patient age on management decisions in breast cancer, and attempted to identify national consensus on this issue. One hundred thirty-three relevant specialists, including 75 surgeons and 43 oncologists, participated in a virtual consultation using e-mailed questionnaires and open-ended discussion documents, culminating in the development of proposed consensus statements sent to participants for validation. A strong consensus was seen in favor of incorporating minimum standards of diagnostic services, treatment, and care for older patients with breast cancer into relevant national guidance, endorsed by professional bodies. Similarly, an overwhelming majority of participants agreed that simple, evidence-based protocols or guidelines on standardizing assessment of biological and chronological age should be produced by the National Institute for Health and Clinical Excellence and the Scottish Medicines Consortium, developed in collaboration with specialist oncogeriatricians, and endorsed by professional bodies. A further recommendation that all breast cancer patient treatment and diagnostic procedures be undertaken in light of up-to-date, relevant scientific data met with majority support. This study was successful in gauging national specialist opinion regarding the effect of patient age on management decisions in breast cancer in the U.K.

"De rappels en prédictions, savoir convaincre et savoir agir : le rôle ambigu de Merlin, de la naissance d'Arthur à son accès au trône de Bretagne (dans le Merlin en prose et la Suite Vulgate)"

Bénéficiant de la connaissance du passé, du présent et du futur, Merlin ne se contente pas de rappeler, observer, ou prédire, mais il agit et influence le cours de l'histoire en favorisant la conception problématique d'Arthur. L'étude porte sur la nature et la portée de son investissement dans une trame narrative où il n'a de cesse d'argumenter, de convaincre, et de se justifier.

A escola de ensino médio público noturno: uma conjuntura favorável ao protagonismo estudantil coletivo em contraposição ao protagonismo juvenil via empoderamento

Ce travail etude le protagonisme juvénile en école de enseignement sécondaire publique, avec emphase a l enseignement nocturne. Considere las médiations que determinent le paradigme du protagonisme juvénile defendu pour théoriciens pos modernes et documents de reforme de enseignement sécondaire brésilien. Montre que les explications sur le protagonisme juvénile font part d une conception de pouvoir juvenile, proposé pour organismes multilatérales avec la volonté de mobiliser les jeunes pauvres pour faire actions du combat a pauvreté dans les nations sur le point de développement, conjoncture auquel sont proposées théories et pratiques que viabilizent la subsistance des jeunes pauvres en situation de risque. Discute la question de pouvoir juvenile et indique que la proposition de le protagonisme juvénile via pouvoir ont une espace favorable dans le sphère du enseignement sécondaire, niveau de la plupart de jeunes. Montre que la défense de pouvoir juvenile occulte chances de actions étudiants collectifs que permetent une intervention sociopolitique au élève de enseignement sécondaire, qui ont selement une function de homologation. Propose une recherche de possibilités de incentifs a le protagonisme juvénile collectif ou protagonisme étudiant collectif, auquel le étudiant presente suggestions pour le planification et éxecution de activités didactique pédagogiques dans l`école publique de enseignement sécondaire. Defend que la gestion démocratique, avec emphase en procès participatif, c est la principal déterminacion pour le protagonisme étudiant collectif. Méthodiquement , considere las dimensions suivantes pour le protagonisme juvénile: a) configuration de protagonisme juvénile b) protagonisme juvénile dans perspective légal/institutionel ; c) enseignement sécondaire et protagonisme juvénile ; d) possibilité de construction de protagonisme étudiant collectif dans enseignement sécondaire nocturne en Rio Grande do Norte, état choisi pour recherche. Sistematize une technique de revision de litérature sur le thème et informations d une consultation de documents, au-delà de donné constants de Banc de donées de la recherche Le Enseignement Sécondaire Publique Nocturne :registre et analyse de expérience dans l état de Rio Grande do Norte. Conclusion : il faut contribuer pour débats sur la participation politique de les jeunes dans le enseignement sécondaire nocturne, en presentant possibilités reéles de protagonisme étudiant collectif ; opinions presentées pour élèves sont très importantes a une direction d un rôle académique fait pour institutions scolaires dans ce moment , parce que des étudiants sont correspondants a interlocuteurs privilégiés ; le élève peut et deut être consulté depuis le moment de élaboration jusqu a réalisation de activités scolaires ; bien que il y a des entraves et difficultés immanents au enseignement sécondaire publique nocturne, se forment noveaux espaces de démocratisation de idées

Early nephrology consultation can have an impact on outcome of acute kidney injury patients

Background. Patients who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality and morbidity. The objectives of this study were to compare clinical and laboratory characteristics of AKI patients evaluated and not evaluated by nephrologists in ICU and generate the hypothesis of the relationship between timing of nephrology consultation and outcome.Methods. We explored associations among presence and timing of nephrology consultation with ICU stay and in-ICU mortality in 148 ICU patients with AKI at a Brazilian teaching hospital from July 2008 to May 2010. Multivariable logistic regression was used to adjust confounding and selection bias.Results. AKI incidence was 30% and 52% of these AKI patients were evaluated by nephrologists. At multivariable analysis, AKI patients evaluated by nephrologists showed higher Acute Tubular Necrosis-Index Specific Score and creatinine level, more dialysis indications, lower urine output and longer ICU stay. The mortality rate was similar to AKI patients who were not evaluated. Nephrology consultation was delayed (>= 48 h) in 62.3% (median time to consultation, 4.7 days). Lower serum creatinine levels (P - 0.009) and higher urine output (P = 0.002) were associated with delayed consultation. Delayed consultation was associated with increased ICU mortality (65.4 versus 88.2%, P < 0.001).Conclusions. In AKI, patients evaluated by nephrologists seem to be more seriously ill than those not evaluated and present similar mortality rate. The delayed nephrology consultation can be associated with increased ICU mortality.

Nursing consultation applied to hypertensive clients: application of orem's self-care theory

O objetivo foi implantar a Consulta de Enfermagem para indivíduos hipertensos, utilizando-se a teoria do autocuidado de Orem e sistematizar a assistência de enfermagem. Foram entrevistados 56 pacientes, sendo 58,9% mulheres, 75% na faixa etária de 50 a 80 anos, 76,4% casados, 42,9% donas de casa, 47,2% aposentados e 67,3% com ensino fundamental completo. Utilizou-se instrumento estruturado abordando os requisitos de autocuidado universal, de desenvolvimento e de desvios de saúde. A análise dos dados possibilitou avaliar os requisitos de autocuidado alterados. No planejamento da assistência, as ações de apoio-educação foram prioridades. A teoria do autocuidado possibilitou identificar aspectos importantes para serem trabalhados pelo enfermeiro.

Psychiatric disorders and psychiatric consultation in a general hospital: A case- control study

Introduction: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). Methods: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD- 10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. Results: Behavioral alterations, either of elation or of depression, were the main for requesting a PC; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). Discussion: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newly-established service will improve the diagnostic and treatment skills of our students.

Intergovernmental dialogue and consultation processes on international migration in the Americas

Includes bibliography

Les paradigmes économiques et le rôle de l'État en Amérique Latine

Inclut la bibliographie

Reestructuración y revitalización de las Naciones Unidas en las esferas económica y social: papel y funciones de la CEPAL = Restructuring and revitalization of the United Nations in the economic and social fields: role and functions of ECLAC = Restructuration et revitalisation de l'Organisation des Nations Unies dans les domaines économique et social: rôle et fonctions de la CEPALC

Incluye Bibliografía