Medical consultation in ulcerative colitis:Key elements for improvement

Ulcerative colitis(UC)is a chronic inflammatory disease with a high impact.In order to improve patient outcomes,the clinician-patient relationship in daily practice is critical.Clinical guidelines provide a framework for UC diagnosis and treatment.However,standard procedures and the medical content focused upon medical consultations in UC patients has not yet been defined.Moreover,UC is a complex disease,given that patient characteristics and patient needs have been proven to vary during clinical consultation since establishing the diagnosis and upon the course of the disease.In this article,we have discussed the key elements and specific objectives to consider in medical consultation,such as diagnosis,first visits,follow-up visits,active disease patients,patients on topical therapies,new treatment initiation,refractory patients,extra-intestinal manifestations,as well as challenging situations.The key elements have been mentioned to comprise effective communication techniques,motivational interviewing(MI),as well as information and educational aspects,or organizational issues.The key elements to be implemented in daily practice were reported to comprise several general principles like duly prepared consultations,in addition to honesty and empathy with patients,as well as effective communication techniques,MI,information and educational points,or organizational issues.The role of other healthcare professionals such as specialized nurses,psychologists,or the use of checklists was also discussed and commented on.

Study on the Consultation Mechanism of an Internet-Based Remote Fault Diagnosis System

Aimed at the deficiency of the mechanism of management and consultation, an idea of an internet-based Virtual Diagnosis Center （VDC） for machine fault is proposed, and the key elements of remote consultation are abstracted. Around the key elements, the construct scheme and cooperative mechanism among experts of VDC are designed. According to the diagnosed object, the context knowledge of a fault machine, fault cases and ActiveX-based analysis tools are integrated into a multimedia consultation environment in VDC to enhance the efficiency of expert consultation. Simultaneously, the technique of push subscription in a SQL Server is utilized to collect machine condition data in an enter- prise machine condition database, which ensures the security of the database. The VDC system in Xi＇an Jiaotong University has been applied to remote diagnosis of a blower in Wuhan Iron and Steel Corporation and the system construction reasonableness and the running stability are verified.

Determinants of the Frequency of Prenatal Consultations among Women Giving Birth in the Maternity Wards of the Commune of Agbangnizoun (Zou), Benin

Antenatal care is a safe way to prevent pregnancy-related health problems, difficult deliveries and even further to anticipate low birth weight [1]. But pregnant women, especially in Africa, do not attend antenatal clinics as recommended by the WHO. The general objective of this study was to study the norm in terms of Antenatal Consultation (ANC) frequency as well as the determinants of the frequency among women who gave birth in the maternity hospitals of Agbangnizoun. Our research was a cross-sectional, descriptive, retrospective and quantitative type, which was carried out among 335 women in Agbangnizoun, Benin from 1 February to 3 April 2020 (3 months), in order to find out the general or specific characteristics of women that we associate with the frequency of prenatal consultation. At the end of the study, we found that 60%, 68% and 15% of the surveyed population had received ANC in the first, second and third trimesters, respectively. Ethnicity, income level of spouses over the three trimesters as well as the level of their knowledge and overall practice of ANC are determinants of the frequency of prenatal consultation.

基于Consultant Climate导向与斯维尔验证的烟台某售楼处节能改造研究

以烟台某售楼处节能改造项目为例,通过Consultant Climate分析帮助设计者快速找到主要能耗矛盾并进行节能改造,再利用斯维尔进行改造后的评价。结果显示:Consultant Climate能够快速找到地区气候缺陷并提出量化策略,斯维尔能够准确合理给出节能率。结合两者可以帮助设计者快速准确地找到适应气候的设计策略,提高工作效率,避免因气候调节能力不佳导致重新改造所带来的资源浪费。

Accidental placement of venous return catheter in the superior vena cava during venovenous extracorporeal membrane oxygenation for severe pneumonia: A case report

BACKGROUND Venovenous extracorporeal membrane oxygenation(V-V ECMO)has become an important treatment for severe pneumonia,but there are various complications during the treatment.This article describes a case with severe pneumonia success-fully treated by V-V ECMO,but during treatment,the retrovenous catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.The ECMO was safely withdrawn after multidiscip-linary consultation.Our experience with this case is expected to provide a reference for colleagues who will encounter similar situations.CASE SUMMARY A 64-year-old man had severe pulmonary infection and respiratory failure.He was admitted to our hospital and was given ventilation support(fraction of inspired oxygen 100%).The respiratory failure was not improved and he was treated by V-V ECMO,during which the venous return catheter,which was supposed to be in the right internal vein,entered the superior vena cava directly in the mediastinum.There was a risk of massive mediastinal bleeding if the catheter was removed directly when the ECMO was withdrawn.Finally,the patient underwent vena cava angiography+balloon attachment+ECMO with-drawal in the operating room(prepared for conversion to thoracotomy for vascular exploration and repair at any time during surgery)after multidiscip-linary consultation.ECMO was safely withdrawn,and the patient recovered and was discharged.CONCLUSION Patients may have different vascular conditions.Multidisciplinary cooperation can ensure patient safety.Our experience will provide a reference for similar cases.

基于Climate Consultant的现代民居被动式优化策略分析——以豫北地区为例

为改善豫北地区现代民居室内热环境状况,提高民居气候适应能力。采用Climate Consultant软件分析豫北地区的气候数据,得出了适用于该地区的被动式建筑策略组合及各策略有效时间比。结合冬夏两季现代民居室内外的热环境实测数据,针对夏季炎热和冬季寒冷问题分别提出了被动式优化策略:民居功能分区设计采用“向心性”的空间布局、冬季在一层檐廊处增设阳光间、改善围护结构保温隔热设计;夏季疏通建筑自然通风的路径、增设遮阳设施、改善庭院绿化。通过以上适宜性被动式优化策略,提高现代民居室内热舒适性,为豫北地区现代民居的建设和改造提供了重要的理论依据和有价值的参考。

Physicians’Perception of Palliative Care Consultation Service in a Major General Hospital in China

Objectives The in-hosptial palliative care consultation(PCC)is emerging as a routine service in some medical center in China.The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team,and37consultations were completed in2016.A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team.Physicians who applied for consultation in2016formally(requested from the department other than the Geriatrics)and informally(by rotating residents and unemployed visiting doctors in geriatric department)were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were103physicians participated in the survey,including primary care physicians from the department of Internal Medicine(n=8),Gynaecology(n=16)and Surgery(n=13),rotating residents(n=30),visiting doctors(n=16)in Geriatric department,and PCC team members(n=20).94.0%of the non-PCC physicians agreed that PCC relieved the suffering of patients;89.2%thought PCC improved the quality of patients'life;there were91.6%,95.2%,90.4%physicians who felt it relieved the anxiety of patients,of family members and of care providers,respectively.There were96.4%physicians who felt it could ease the tension in physician-patient relationship;97.6%felt it lower the risk for medical negligence,and96.4%of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation.More primary-team physician agree"PCC service helps the physicians better understand palliative care"than PCC members(97.6%vs.80%,P<0.05),while both were interested in learning more on palliative medicine(100%vs.96.4%,P>0.05).

Reliable transmission of consultative committee for space data systems file delivery protocol in deep space communication

In consultative committee for space data systems（CCSDS） file delivery protocol（CFDP） recommendation of reliable transmission,there are no detail transmission procedure and delay calculation of prompted negative acknowledge and asynchronous negative acknowledge models.CFDP is designed to provide data and storage management,story and forward,custody transfer and reliable end-to-end delivery over deep space characterized by huge latency,intermittent link,asymmetric bandwidth and big bit error rate（BER）.Four reliable transmission models are analyzed and an expected file-delivery time is calculated with different trans-mission rates,numbers and sizes of packet data units,BERs and frequencies of external events,etc.By comparison of four CFDP models,the requirement of BER for typical missions in deep space is obtained and rules of choosing CFDP models under different uplink state informations are given,which provides references for protocol models selection,utilization and modification.

Patient Participation in Communication about Treatment Decision-Making for Localized Prostate Cancer during Consultation Visits

Objectives: To describe the communication behaviors of patients and physicians and patient par-ticipation in communication about treatment decision-making during consultation visits for local-ized prostate cancer (LPCa). Methods: This is a secondary analysis of data from 52 men enrolled in the usual care control group of a randomized trial that focused on decision-making for newly diagnosed men with LPCa. We analyzed the patient-physician communication using the transcribed audio-recordings of real-time treatment consultations and a researcher-developed coding tool, including codes for communication behaviors (information giving, seeking, and clarifying/ verifying) and contents of clinical consultations (health histories, survival/mortality, treatment options, treatment impact, and treatment preferences). After qualitative content analysis, we categorized patient participation in communication about treatment-related clinical content, including “none” (content not discussed);“low” (patient listening only);“moderate” (patient providing information or asking questions);and “high” (patient providing information and asking questions). Results: Physicians mainly provided information during treatment decision consultations and patients frequently were not active participants in communication. The participation of patients with low and moderate cancer risk typically was: 1) “moderate and high” in discussing health histories;2) “low” in discussing survival/mortality;3) “low and moderate” in discussing treatment options;4) “none and low” in discussing treatment impacts;and 5) “low” in discussing treatment preferences. Conclusions: Findings suggest opportunities for increasing patient participation in communication about treatment decision-making for LPCa during clinical consultations.

Update summarising the conclusions of the international consultation on male lower urinary tract symptoms

The International Consultation on Urological Disease have recently published comprehensive conclusions, based on evidence reviewed by eight committees, on aspects of male lower urinary tract symptoms(LUTS). In this review, we summarise the conclusions from fourof the committees, namely, the evidence regarding the epidemiology of male LUTS, patient assessment, nocturia and medical management. It is indisputable that with an expanding and ageing global population the prevalence of male LUTS is likely to increase. Therefore symptom prevention and preservation of quality of life(Qo L) feature highly in the guidelines. There are now a number of different medical options, proven to lead to significant improvements in symptom scores, flow rate and Qo L available to men with LUTS. Metaanalyses have shown the benefits for alpha blockers, antimuscarinics, 5-α reductase and phosphodiesterase-5 inhibitors. High level evidence also exists for combinations of all of the above with alpha blockers and so men with concomitant storage symptoms, prostate volume > 30 mL, PSA > 1.4 or erectile dysfunction may be considered for combination treatment of an alpha blocker with an antimuscarinic, 5-α reductase inhibitor or phosphodiesterase-5 inhibitor respectively. In an era of personalised medicine, appropriate patient selection is likely to provide the key to the most effective clinical management strategy.

Function of Management Consultation in Implementation of ERP Project

ERP(enterprise resource planning) is a huge and com pl ex system engineering which costs a great lot of fund and manpower. It is a refo rm in the enterprise management mode, management idea and management method whi ch needs mass fund import, with long period, full of risk, hard to perform and can’t show its effects at once. The essence of the enterprise performing in ERP system is to run a "management engineering", which involves integration of opera tion process. The integration will touch business culture, enterprise system,m eans of operation and the department’s regulatioins amongst the operation conten ts, rights and responsibilities. Totally, the ERP system is the rebuilding of ma ngagement idea, method and means, which needs the common acquaintance from the t op management to the whole stuff.Meantime, it requires a perfect tactic to perfo rm an ERP system. We must confirm a cut-in spot as the right space to start bas ed on the enterprise requirement and the application environment. And to choose a right space decides that the application of ERP system is successful or not. S o, we must make it clear to build which subsystem first, to take the right seque nce for performing all kinds of function modules and the final integrated functi ons . All this prepared work for the implement of ERP system and the management, the recombination and optimization of enterprise management operation flow, ite m management and harmonization, ERP educational training and so on can not be pe rformed well without management consultancy. The effective management consultan cy can lead then implement of ERP system to shorten the executive cycle, to quik en the realization of effect and to harmonize the relationship to the client ent erprises so that to ensure the successful perform of ERP.

Consultation, Diagnosis and Treatment Delays for Breast Cancer among Patients Followed up at the YaoundéGeneral Hospital, Cameroon

Introduction: Breast cancer is often diagnosed at an advanced stage in Cameroon. The objective was to analyse consultation, diagnosis and treatment delays for breast cancer among patients followed up at the Yaoundé General Hospital (YGH) in Cameroon. Materials and Methods: This was a cross-sectional study carried out from the files of patients followed up for breast cancer at the YGH from January 1, 2014 to April 30, 2018. A total of 183 patients were included. We measured time elapsed between the awareness of first signs of disease and the initial consultation (consultation delays), time lapse between the initial consultation and pathological diagnosis of breast cancer (diagnosis delays), interval between pathological diagnosis and treatment onset (treatment delays), time elapsed between the initial consultation and management (health system delays) and time elapsed from awareness of first signs of disease to treatment onset (overall delays). Results: The delays (median, IIQ) were: (5.1 months;IIQ: 1.7 - 12.4), (25 days;IIQ: 10 - 67), (27 days;IIQ: 13 - 63), (2.2 months;IIQ: 1.2 - 5.8) and (9.9 months;IIQ: 4.4 - 17.6) respectively for consultation, diagnosis, treatment, health system and overall delays. The risks associated with a delay in initial consultation of greater than 3 months were (OR;95% CI): unschooled patients (2.01;1.66 - 2.40);monthly income below the minimum wage (2.70;1.81 - 5.96);unemployment (2.14;1.02 - 3.24) and absence of a family history of cancer (2.44;1.66 - 6.10). The main reasons for a late first consultation were: ignorance (60.2%), financial challenges (17.6%) and a preference for alternative treatment (11.1%). Conclusion: The consultation, diagnosis and treatment delays for breast cancer are very often long in our setting than those reported in developed countries. Both patients’ and institutional factors are demonstrated. There is a need to increase public awareness on the value of early diagnosis of breast cancer. Also, health system should be improved to enable early diagnosis and treatment of this affection.

First Consultation in Nephrology: Case of the Point G University Hospital (Bamako-Mali)

Understanding the first consultation of people with kidney disease seems to us to be essential to understand the attitude of the referring physician and the nephrologist. The aim was to find out to whom a patient with kidney disease should be referred in the first instance and for what reason? Hence the evaluation of the prevalence of the first consultation in the nephrology department of the Point G University Hospital in Bamako was made. Patients and Method: This was a prospective descriptive study which took place from July 2017 to June 2018 in the nephrology department of the Point G University Hospital. The study included all patients who came to the nephrology department for the first time during this period. Results: Between July 2017 and June 2018 at the nephrology and haemodialysis service of the G point University Hospital, we retained 643 out of 1031 patients who came for their first consultation, i.e. 62.36%. There were many patients aged between 41 and 50 years. The average age was 42.6 ± 5.03 years with extremes of 30 and 82 years. The sex ratio (M/F) was in favor of males, 1.14. The majority of patients were referred/evacuated from the referral health centres (57.6%). The majority of patients were referred/evacuated by general practitioners (70.5%). Cardiologists were the main specialists to refer/evacuate patients (21.2%). The main reasons for consultation that led to the first diagnostic hypotheses were: arterial hypertension for vascular nephropathy, glomerular syndrome for glomerular nephropathy, acute uraemia syndrome for acute renal failure, hydronephrosis for obstructive uropathy and finally diabetes for diabetic nephropathy. Conclusion: The first consultation in nephrology remains an important step in the management of renal disease, especially when the referral is an emergency. The percentage of referrals is dominated by general practitioners.

Global Dryland Ecosystem Programme(G-DEP):Africa consultative meeting report

In order to enhance and restore the ecosystems of natural capital in African arid regions,the Global Dryland Ecosystem Programme(G-DEP)consultative meeting was hosted in Dakar,Senegal,from 23 to 25 September 2019.This paper details the first African meeting of the G-DEP.Consultative meeting reviewed preceding dryland ecosystems case studies,identified vulnerable arid and semi-arid regions,and proposed sustainable solutions to problems.It also identified the successes and failures of previous attempts to improve vulnerable ecosystems and ultimately formed an action plan to improve these attempts.Climate,ecosystems,and livelihoods for Sustainable Development Goals(SDGs),Great Green Wall Initiative(GGWI)for Sahara and Sahel,and China-Africa cooperation on science,technology,and innovation are three extra main sections concerned of the meeting.Separately,more specific topics as the complicated relationship between these natural processes and human activity,including pastoralism,soil restoration,and vegetation regenerate techniques,were fully discussed.Consultative meeting also identified the positive effects international collaboration can have on dryland regions,specifically in the capacity of sharing information,technology,and innovation on purpose to develop a joint proposal for long-term research programs in African arid and semi-arid areas.Moreover,meetings that review the progress made on ecosystem management for the sustainable livelihoods in Africa,identification of priority areas,and the development and implementation of ecosystem programs for proper research and collaboration in African arid and semi-arid zones,have been proposed as strategic recommendations to enhance the global partnership for sustainable development.Furthermore,as the outcomes of the workshop,there are three steps proposed to handle African dryland climate changes,several aspects suggested to solve current dilemmas of the GGWI,and a series of actions recommended for G-DEP related activities in Africa.

TdBrnn:An Approach to Learning Users’Intention to Legal Consultation with Normalized Tensor Decomposition and Bi-LSTM

With the development of Internet technology and the enhancement of people’s concept of the rule of law,online legal consultation has become an important means for the general public to conduct legal consultation.However,different people have different language expressions and legal professional backgrounds.This phenomenon may lead to the phenomenon of different descriptions of the same legal consultation.How to accurately understand the true intentions behind different users’legal consulting statements is an important issue that needs to be solved urgently in the field of legal consulting services.Traditional intent understanding algorithms rely heavily on the lexical and semantic information between the original data,and are not scalable,and often require taxing manual annotation work.This article proposes a new approach TdBrnn which is based on the normalized tensor decomposition method and Bi-LSTM to learn users’intention to legal consulting.First,we present the users’legal consulting statements as a tensor.And then we use the normalized tensor decomposition layer proposed by this article to extract the tensor elements and structural information of the original tensor which can best represent users’intention of legal consultation,namely the core tensor.The core tensor relies less on the lexical and semantic information of the original users’legal consulting statements data,it reduces the dimension of the original tensor,and greatly reduces the computational complexity of the subsequent Bi-LSTM algorithm.Furthermore,we use a large number of core tensors obtained by the tensor decomposition layer with users’legal consulting statements tensors as inputs to continuously train Bi-LSTM,and finally derive the users’legal consultation intention classification model which can comprehensively understand the user’s legal consultation intention.Experiments show that our method has faster convergence speed and higher accuracy than traditional recurrent neural networks.

Evaluation of the Quality of Prenatal Consultation in Rural Area of Mali, Case of Kadiolo Health District

Every woman has the right to receive satisfactory quality prenatal care in reproductive health. Giving a life while remaining alive and without sequelae must be the slogan of any gynecologist - obstetrician and midwife, as well as any health worker. It was a descriptive cross-sectional study dealing with the evaluation of the quality of prenatal consultations at the Kadiolo referral health center (or RHC). Adevis Donabedian’s model for assessing the quality of care and services served as a benchmark. According to Donabedian quality means good technical care, with good interpersonal relationships, and adequate and comfortable premises. This study took place from April 24 to December 04, 2017 and aimed to assess the current level of the quality of prenatal consultations at the Kadiolo referral health center, to study the structures in place including infrastructure and personnel, to specify the procedures and to determine their results. This work has permitted us to classify the RHC of Kadiolo at level III with 85%, which means that the references evaluated were satisfactory, with the level of 75% to 94%. In terms of structure, a pricing system was deemed affordable by the opinion of pregnant women. The analysis of the level of the human dimension revealed that the health center was level III. The pregnant women were satisfied with the reception which was good in 76% of the cases, as well as with the quality of the respect of the privacy in 96% and confidentiality in 95%. Despite the satisfaction of pregnant women, gaps remain to be filled in concerning the quality of the services received at the Kadiolo referral health center so as to reach level IV.

Hello,can you hear me?Orthopaedic clinic telephone consultations in the COVID-19 era-a patient and clinician perspective

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has resulted in seismic changes in healthcare delivery.As a result of this,hospital footfall required to be reduced due to increased risk of transmission of infection.To ensure patients can safely access healthcare,we introduced orthopaedic clinic telephone consultations in our busy district general hospital.AIM To investigate patients’and clinicians’perspective of telephone consultations during COVID-19,and whether this method of consultation could be a viable option in the post-pandemic future.METHODS This is a single centre,prospective study conducted in a busy National Health Service district general hospital.In May 2020,100 non-consecutive adult patients were contacted by independent investigators within 48 h of their orthopaedic clinic telephone consultation to complete a telephone satisfaction questionnaire.The questions assessed satisfaction regarding various aspects of the consultation including overall satisfaction and willingness to use this approach long term.Satisfaction and perspective of 25 clinicians conducting these telephone consultations was also assessed via an online survey tool.RESULTS 93%of patients were overall satisfied with telephone consultations and 79%were willing to continue this method of consultation post-pandemic.Patients found telephone consultations to reduce personal cost and inconvenience associated with attending a hospital appointment.72%of clinicians reported overall satisfaction with this service and 80%agreed that telephone consultations should be used in the future.The majority found it less laborious in time and administration in comparison to face to face consultations.Patients and clinicians expressed their desire for video consultations as a method of further improving their experience with remote consultations.CONCLUSION Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic,achieving the aim of reducing hospital footfall.This method of consultation has resulted in immense clinician and patient satisfaction.Our findings suggest that this tool has benefits in post pandemic healthcare delivery.It has also highlighted that telephone consultations can act as a steppingstone to the introduction of the more complex platform of video consulting.

Epidemiological Profile of Diagnosed Disorders in Urological Consultation at Sylvanus Olympio Teaching Hospital in Lome

Context: Thanks to the increase in the number of urologists in Togo, urological activity is improving rapidly. Objective: This study aims at presenting the epidemiological aspects of the diseases diagnosed in urology consultation at the Sylvanus Olympio Teaching Hospital in Lome. Materials and Methods: This research was a two-year retrospective and descriptive study. The data for the analysis were collected from the records of patients received in consultation for urological pathology. The parameters taken into account are: frequency, age, sex, occupation, patient history and diagnosis. Results: 602 patients were admitted at the department of urology within two years, with an annual frequency of 301. The average age of the patients was 48.63 ± 19.69 years;the sex ratio (M/F) was equal to 12.08. Patients over 60 years of age accounted for 33.3% of the patients seen. The medical history of 88 cases showed that the bladder catheterization was most frequent (22 cases) followed by hypertension (15 cases). Benign prostatic hyperplasia was the most frequently diagnosed pathology accounting for 24.9% of the consultations. Conclusion: Benign prostatic hyperplasia is the most frequent pathology in urology consultation at the Sylvanus Olympio Teaching Hospital in Lome.

How consultation-relational empathy and demographics influence satisfaction with primary antenatal health care:evidence from rural Nigeria

Objectives:This study aims to explore the role of consultation and relational empathy(CARE)and socio-demographic profile as predictors of patients'satisfaction among pregnant women attending antenatal care(ANC)in selected public primary health facilities in rural sub-districts of Saki,Oyo State,Nigeria.Methods:This cross-sectional study recruited a total of 582 pregnant women in four primary health centers.Expectant mothers responded to a questionnaire covering demographic characteristics,clinic visitation,CARE,and patients'satisfaction.All data was analyzed using descriptive,univariate and multivariate statistical tools.P<0.05 level was considered statistically significance.Results:Findings revealed that the participants had a mean age of 23.15±5.23 years.The pattern of patients'satisfaction revealed that 13.40%(78/582)were highly satisfied with the health care received compared to 86.60%(504/582)with moderate to low satisfaction ratings with ANC.Highly satisfied patients placed higher value on technical quality,interpersonal relation,communication,financial aspects,time spent and accessibility convenience(P=0.001).Multiple linear regression model indicated that relational empathy(β=0.28,P<0.001),2nd trimester of pregnancy(β=0.13,P=0.01),age categories of 30-<40 years(β=-0.12,P=0.02),and 40-<50 years(β=-0.11,P=0.04),religious affiliation(β=0.10,P=0.03)predicted satisfaction with ANC.Conclusion:Low patients'satisfaction with antenatal healthcare services resulting from hostile attitudes from health workers has implication for the delivery and acceptability of services offered to eradicate maternal mor-tality globally.Thus,regular training and re-training of health care personnel in frequent contact and interaction with patients will go a long way in reducing untoward work attitude and maternal mortality in rural ANC centers globally.