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May 2020 DOI 10.14302/issn.2692-5257.ijgp-20-3335
Luis Turabian JoseCorresponding author
Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
The consultation is the activity of meeting and communication between an individual and the doctor for the knowledge and solution of a health problem. In today's busy world of general medicine, constant demands for the general practitioner (GP) arise: she or he should not only make a diagnosis not only should make a differential diagnosis during consultation, but must also establish a good relationship, explore patient ideas, concerns and expectations and negotiate a management plan, taking into account limited resources, the quality framework and results, having Information technology skills, plus, the need to promote health during any consultation. Normally the GP has only 10 minutes to achieve all that, as well as to manage your own emotions, agendas and uncertainty. In this way, novice doctors may find it difficult to move in this situation of complexity, and they can also observe a gap in the literature that really guides them in practice. Rigorous preparation is the key to success for many endeavours. Some tips to perform an efficient and safe consultation work in general medicine are suggested: 1) Focus on the next patient; 2) Preparing the consultation before entering the patient, memorizing the patient's previous history; 3) Establishing a connection with the patient; 4) Remembering the elements that must be in each consultation (the current reason, update other previous processes, chronic diseases and continued attention, "case finding", health promotion); 5) Striking a balance between empathy and assertiveness; 6) Putting in writing and contextualized the clinical record; and 7) Making reflection-safety questions, learning questions, and preparation questions for the next visit. Rigorous preparation is the key to success for the general practitioner in every consultation. Think about these topics of the consultation before doing it, and after it, prepare the next consultation of that patient. All these things are force multipliers.
Apr 2022 DOI 10.14302/issn.2379-7835.ijn-22-4155
Salissou Seck Mbaye MBAYECorresponding author
Cardiology Department of the Yalgado Ouédraogo University Hospital, Ouagadougou (Burkina Faso)
The diabetic is most of the time admitted in emergency for acute complications. An inventory of these complications will guide promotional programs aimed at preventing the occurrence of these complications. This study was conducted with the aim of identifying acute complications and decompensation factors in diabetics admitted in emergency to the Souro Sanou University Hospital Center (CHUSS).It was an observational study, of descriptive transversal type, with prospective collection for 4 months. It concerned diabetics admitted to the medical and surgical emergency departments of the CHUSS. A total of 90 diabetics were included in the study. The average age was 58.81 ± 14.7 years. Type 2 diabetes accounted for 85.6% of cases. The diagnosis of diabetes was known in 74.4% of cases. The reasons for consultation were dominated by impaired conscientiousness and fever, 54.4% and 50% respectively. Metabolic complications were found in 44.4% of patients. They were dominated by hypoglycemia, which accounted for 55.3% of cases. Dietary error was the main decompensation factor in cases of hypoglycemia and was reported in 71.4% of cases. Metabolic complications are common in diabetics admitted in emergency at the CHUSS. Decompensation factors are mostly preventable.
Dec 2020 DOI 10.14302/issn.2692-5257.ijgp-20-3649
Luis Turabian JoseCorresponding author
Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
The coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 has produced a significant change in the way general medicine is conducted. This shift has been remarkably quick towards telecare. The form of the clinical interview has changed, and with it communication and the doctor-patient relationship; Before COVID-19, all communication techniques and doctor-patient relationship, which were considered tried and true to establish a good relationship with patients, involved physical proximity 2. Now in many European countries and in the United States face-to-face consultations have been reduced to 10-20%, with most contacts now being provided remotely using symptom checkers, electronic messaging, and phone or video consultations 3.
Oct 2020 DOI 10.14302/issn.2329-9487.jhc-20-3584
Lu YuananCorresponding author
School of Economics and management, Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, PR China
Objective To examine the current linkage between different medical services for hypertension patients for enhanced integration among medical service systems. Methods A total of 18 hospitals and community medical centers from a district of Shanghai were enrolled for social network analysis which covered emergency visits and hospitalization records of 171,177 outpatients with hypertension. Stata software was used for data preprocessing and UCINET software was used for network analysis of medical service providers to quantify and visualize the network tightness and the "main role" of information delivery of the medical institution network in the area. Results The service network of hypertension consultation institutions in the region is closely connected as a whole, but the level of diagnosis and treatment of medical services in various communities varies widely, and the degree of association with higher-level medical institutions is not uniform. Conclusion Based on the limited tightness of various medical service providers, it is necessary to implement the responsibilities of individual medical institutions at different levels and pay more attention to improving the service capabilities of primary medical institutions for enhanced integrating medical services in future.
Aug 2020 DOI 10.14302/issn.2474-9273.jbtm-20-3497
Patel JainishCorresponding author
Indira Gandhi National Open University, Regional Center, Surat, Gujarat, India
This paper explores the two major preventive concepts of the unpredictable life-threatening viral infection caused by Coronavirus that is ravaging the entire world from the beginning of the year 2020, as it pertains to mental health. Through scientific consultations, the expectation is that effective vaccine for the Coronavirus disease-2019 (COVID-19) may not come into the market this year. Two (among others) preventive measures, namely Social Distancing and Quarantine are suggested by the World Health Organization (WHO). Using the principle of explorative research, this study established the flipside of quarantine and social distancing from the metal health perspective. It was discovered that there is a relationship between a long period of self-isolation and a high probability of concerned persons having anxiety, stress, and depression, which gradually leads to mental and emotional health issues. Consequently, mental health affects the overall health and affects how we handle different situations during the Covid-19 pandemic. By considering this important matter, this article recommended different ways to improve mental health during the pandemic in the quest to keep oneself away from psychological issues arising due to the Covid-19 situation.
Apr 2020 DOI 10.14302/issn.2692-5257.ijgp-20-3299
Luis Turabian JoseCorresponding author
Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
The coronavirus disease 2019 (COVID-19) pandemic is something new that baffles us. The dominant health model and the theory that supported it until before COVID-19 are refuted or invalidated by observing the current tragically situation, which also implies lasting changes in that new medical model. Consequently, once the urgency of the epidemic is over, the conceptual and organizational building of medical care can no longer be rebuilt in the same way. Based on the COVID-19 experience, it is necessary to rethink what kind of knowledge can emerge. Some of the concepts with clinical-epidemiological implications that have to be re-evaluated since the COVID-19 pandemic are: 1. Large epidemics or changes do not arise from an event similar to the "Big Bang", but rather they develop slowly and underground, so a surveillance system must be instituted; 2. Re-evaluate what we understand by "evidence-based medicine"; 3. Patient-centered care is inadequate and must be replaced by community-centered care; 4. Telecare and changes in the organization of consultations; 5. Hospitals and health centers are "biological bombs" that act as vectors of disease and must change their architecture, organization and use; 6. The end of the nursing home model; 7. Change of habits; and 8. Social media can democratize information and help communities organize.
Mar 2020 DOI 10.14302/issn.2692-5257.ijgp-20-3164
Luis Turabian JoseCorresponding author
Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
There is a gap between theoretical knowledge about strategies and the techniques or methods to apply in the practice of the consultation to improve compliance. Within the framework of these strategies, a number of techniques to be used in certain situations can be cited: 1) Assessing readiness to change, importance and confidence; 2) Instruments for decision support; 3) Technique of the "pros and cons"; 4) Auto-monitoring techniques; 5) Technique of "information exchange"; 6) Feedback technique; 7) Brainstorming; 8) The “typical day”; and 9) Practical reminder systems for taking medication. A certain technique is not a universal procedure, but it is usually refined by trial and error, based on past experiences, and their choice and design are the responsibility of the general practitioner.
May 2019 DOI 10.14302/issn.2574-4526.jddd-19-2770
Remy Andre-JeanCorresponding author
Mobile Hepatitis Team, Perpignan Hospital, France
Introduction In France 33% of patients didn’t take care of hepatitis C because there were no diagnosed. Drug injection was main contamination route of hepatitis C virus (HCV) in France. French guidelines were to treat all inmates and drug users, even fibrosis level. Access of HCV screening, care and treatment in drugs users, prisoners and homeless was low in France. They were considered as difficult to treat populations. All these patients need specific support. Hepatitis Mobile Team (HMT) was created in July 2013 to increase screening care and treatment of hepatitis B and C patients. HMT was composed of hepatologist, nurses, social workers and health care worker. Objective increase outreach screening care treatment access and cure of our target population. Patients and methods Target population was drugs users, prisoners, homeless, precarious people, migrants and psychiatric patients. We proposed part or all of our services to our 42 medical and social partners: HCV HBV screening by DBS (dried blood test); outside DBS and FIBROSCAN in converted van; Outreach open center; Drug users information and prevention, Free blood tests in primary care;, Staff training; Social screening and diagnosis; Mobile liver stiffness Fibroscan in site; Advanced on-site specialist consultation; Easy access to pre-treatment commission; Low cost mobile phones for patients; Individual psycho-educative intervention sessions; Collective educative workshops; Peer to peer educational program; Specific one day hospitalizations. All services were free for patients and for partners. Results from 2013 July to 2018 December, we did 8382 DBS for 5382 people (3053 HCV DBS) and 2302 Fibroscan*. HCV new positive rate was 21.3%. Our HCV active file was 651patients included these 24.8% new patients screened by DBS; 98% realized HCV genotype, HCV viral load and FIBROSCAN. DAA treatment was proposed to 96%; 95% started treatment, 4% were lost follow up or refused treatment. After treatment, there was 7 relapse and 3 reinfections by drug injection and cured rate of 94%. Sociological evaluation showed that 4 program qualities for patients: free access, closeness (outside hospital), speed (of the results) and availability (of nurse and social workers). Conclusions: Specific follow-up of drugs users and other HCV high-risk patients including screening, early detection, diagnosis and treatment increase rate of treated and cured patients, with low rate of relapse and reinfections.
Nov 2018 DOI 10.14302/issn.2640-690X.jfm-18-2485
Luis Turabian JoseCorresponding author
Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.
The transcendence of the doctor-patient relationship is given by the confirmed fact of its influence on the results of health care. Several models of doctor-patient relationship can be described, but evidence of improved compliance, satisfaction and recall of physician information has been found in patient-centered consultations. Since these concepts of doctor-patient relationship and patient-centered consultation have multiple facets, they are complex to understand and teach. Using a metaphor is a tool that can be useful in these situations. We could say that the "good" doctor-patient relationship is a process where an "alliance" is created: a process in which the doctor adapts to the rhythm of the patient and little by little can help him move towards healthier scenarios; that is, detect "what dance the patient dances and like a good dancer, take a step back, another forward, dancing and pacing with the patient. But there is not a single type of "good" or "adequate" doctor-patient relationship; there is not "a single dance that the patient dances". If "the doctor has to dance with the patient", he has to know that there are many types of dance! The doctor will have to dance dances such as Cha-Cha (which has to be slow or very fast to dance), the Mambo (where the music is faster and the rhythm more complicated - the relationship with an urgent patient); the Merengue (which is danced like walking - informal doctor-patient relationship); el Pasodoble (that you have to dance with a haughty air, but not with rigidity -synchronizing assertiveness and empathy); The Salsa (where you have to learn the basic step separately - discontinuity of the doctor-patient relationship), among others.
Sep 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1694
Coulibaly R BereteCorresponding author
Ophthalmology Department of University Hospital of Treichville
Introduction: Squamous cell carcinomas of the conjunctiva (SCC) are rare neoplasia but have a high rate of increase and a high rate of mortality, especially when they occur in the context of Human Immunodeficiency Virus (HIV) infection. The objective of this study was to establish an epidemiological and clinical profile of SCC in patients living with HIV and to assess its evolutionary characteristics. Patients and Methods: this was a descriptive cross-sectional study carried out over a period of 5 years in the ophthalmology department of the University Hospital of Treichville. The data collected focused on epidemiological, clinical, pathological, therapeutic and evolutionary elements. Twenty tree eyes of 23 patients were examined during this period. Results: The average age of our patients was 45 years with extremes ranging from 31 to 60 years. A female predominance was observed with a sex ratio of 0.92. The average consultation period was 18 months with extremes ranging from 6 to 60 months. Physically, 35% of our eyes (08 eyes) presented a functional loss of the eye. All our patients had a HIV positive status with 16 cases of HIV1 infection, 4 cases of HIV 2 infection and 3 cases of HIV 1 and 2 co-infection. Lymphocyte typing was performed for 15 patients out of the 23 With CD4 cell counts ˂ 200 in 30.43% of cases, between 200 and 500 in 34.78% of cases. All our tumors had had biopsy excision with pathological examination. A postoperative adjuvant topical chemotherapy in 6 cases. The average follow-up period of our patients was 29 months. In all cases, it was invasive differentiated squamous cell carcinoma. Discussion: HIV infection is a risk factor for the occurrence of conjunctival squamous cell carcinoma, but it is also an aggravating factor especially in the case of low CD4 cell count, particularly in sub-Saharan Africa, where the fight against infection, although boosted in these recent years, is far to achieve all objectives Conclusion: HIV seroprevalence is very often associated with opportunistic infections which include carcinogenic processes such as squamous cell carcinomas of the conjunctiva
Jun 2017 DOI 10.14302/issn.2474-7785.jarh-16-1354
Frumence GastoCorresponding author
Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Tanzania.
Tanzania is among the developing countries experiencing rapid growth of an ageing population, which has an implication in healthcare expenditure especially in resource poor settings where majority of elderly people cannot afford to pay for the cost of accessing health services. The country has developed the Tanzania National Health Policy (2007) and National Ageing Policy (2003), which, among other things, recognize the importance of having a healthcare system that provides free basic services to the vulnerable elderly population. This study aimed at exploring health service providers’ and managers’ perspectives on the factors facilitating or prohibiting access to health services among elderly people in Tanzania. The study adopted a qualitative approach and data were collected using semi-structured interviews. A total of 24 in-depth interviews were conducted with district healthcare managers, heads of public healthcare facilities, and health service providers. The data generated were analysed for themes and patterns. The results show that Tanzania’s healthcare system has made some efforts to implement the national exemption policy to ensure better access to health services for the elderly. Some of these efforts include: having in place a system to identify and exempt elderly people from paying for health services and giving them special priority during treatment. However, there are some barriers hindering elderly people’s access to health services. Among others include: lack of specific consultation rooms and doctors for serving the elderly, and lack of sufficient drugs and other medical equipment in most government-owned healthcare facilities. In summary, the healthcare system has created a good environment for the implementation of exemption policy aiming at enhancing accessibility of health services among the elderly population in the country. However, such environment cannot function effectively without addressing the identified barriers. It is recommended that the government should allocate adequate human and non-human resources to the healthcare system to enable it to function effectively, including the provision of health services to the elderly.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-12-157
Aryal NirmalCorresponding author
Division of Applied Health Sciences, Forester Hill Campus, University of Aberdeen, Aberdeen, Scotland, UK
Background: Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) are found to be strongly associated with cardiovascular diseases. Data are sparse on the prevalence and distribution of cardiovascular risk factors among people being treated for HIV in South Asia region. Methods: A cross-sectional study of 103 HIV patients (51 women and 52 men) attending routine follow-up consultations at the largest ART centre in Nepal was conducted. Data on several cardiovascular risk factors were collected through interview questionnaires, biophysical measurements and consulting medical records. Results: The most common cardiovascular risk factors observed were central obesity 34.6% 95% Confidence Interval (CI): 25.3% to 43.9%, chronic kidney disease {20.7% (95% CI: 11.6% to 29.7%)} and tachycardia {20.6% (95% CI: 12.7% to 28.5%)}. Females were significantly more likely to have central obesity (male 9.8% vs. female 60%, p=0.016) and chronic kidney disease (male 15.4% vs. female 26.3%, p=0.003) as compared to the males. Participants were fairly active but a large proportion, especially men, had smoked {65% (95% CI: 57%-72.3%)}, used tobacco products {66% (95% CI: 56.4%-74.4%)} or drugs (53.8% of the men) and consumed alcohol {60.2% (95% CI: 50.5%-69.1%)}. Conclusion: A high prevalence of several cardiovascular risk factors was observed among patients being treated for HIV in Nepal. Further larger studies are warranted to better understand the relevance and public health impact of cardiovascular risk factors in this region.