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 cl...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.展开更多
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 ...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.展开更多
This study delves into the formation dynamics of alliances within a closed-loop supply chain(CLSC)that encom-passes a manufacturer,a retailer,and an e-commerce platform.It leverages Stackelberg game for this explorati...This study delves into the formation dynamics of alliances within a closed-loop supply chain(CLSC)that encom-passes a manufacturer,a retailer,and an e-commerce platform.It leverages Stackelberg game for this exploration,contrasting the equilibrium outcomes of a non-alliance model with those of three differentiated alliance models.The non-alliance model acts as a crucial benchmark,enabling the evaluation of the motivations for various supply chain entities to engage in alliance formations.Our analysis is centered on identifying the most effective alliance strategies and establishing a coordination within these partnerships.We thoroughly investigate the consequences of diverse alliance behaviors,bidirectional free-riding and cost-sharing,and the resultant effects on the optimal decision-making among supply chain actors.The findings underscore several pivotal insights:(1)The behavior of alliances within the supply chain exerts variable impacts on the optimal pricing and demand of its members.In comparison to the non-alliance(D)model,the manufacturer-retailer(MR)and manufacturer-e-commerce platform(ME)alliances significantly lower both offline and online resale prices for new and remanufactured goods.This adjustment leads to an enhanced demand for products via the MR alliance’s offline outlets and the ME alliance’s online platforms,thereby augmenting the profits for those within the alliance.Conversely,retailer-e-commerce platform(ER)alliance tends to increase the optimal retail price and demand across both online and offline channels.Under specific conditions,alliance behavior can also increase the profits of non-alliance members,and the profits derived through alliance channels also exceed those from non-alliance channels.(2)The prevalence of bidirectional free-riding behavior largely remains constant across different alliance configurations.Across these models,bidirectional free-riding typically elevates the equilibrium prices in offline channel while negatively affecting the equilibrium prices in other channel.(3)The effect of cost-sharing shows relative uniformity across the various alliance models.Across all configurations,cost-sharing tends to reduce the manufacturer’s profits.Nonetheless,alliances initiated by the manufacturer can counteract these negative impacts,providing a strategic pathway to bolster CLSC profitability.展开更多
Ghanaian construction projects encounter a number of challenges, including low health, safety, and environmental requirements, poor performance, and time and cost overruns. To provide value for money (VFM) on governme...Ghanaian construction projects encounter a number of challenges, including low health, safety, and environmental requirements, poor performance, and time and cost overruns. To provide value for money (VFM) on government infrastructure projects in Ghana, this research assesses the roles of project consultants, specifically architects and quantity surveyors, and highlights important obstacles. A cross-sectional survey design involving architects and quantity surveyors yielded a 96% response rate after 100 questionnaires were distributed. Consultants’ responsibilities also include monitoring standards compliance, providing advice on delays, controlling budgets, and advising on project completion dates. Difficulties encompass a lack of promptness in decision-making, unethical conduct, political pressure, and inadequate focus on contract administration and construction audits. Project urgency, longevity, political clout, timely decision-making, and team experience are important variables that impact VFM. Policy makers and construction management practitioners should take note of the implications for Ghana’s public infrastructure projects.展开更多
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 perc...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, and 37 consultations were completed in 2016. 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 in 2016 formally(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 were 103 physicians 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 were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% 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).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.展开更多
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 (LPC...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.展开更多
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 c...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.展开更多
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 re...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.展开更多
<strong>Introduction</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</str...<strong>Introduction</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 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 in</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">i</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">tial 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). </span><b><span style="font-family:Verdana;">Results</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 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) respectiv</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">e</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">ly 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%). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> 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 </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">on</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the value of early diagnosis of breast cancer. Also, health system should be improved to enable early diagnosis and treatment of this affection.</span></span></span>展开更多
Since the 1970s, Chinese seismologists have started to conduct the Annual Consultation on the Likelihood of Coming Earthquakes in the Next Year. This approach has unique scientific and practical merits either as an ac...Since the 1970s, Chinese seismologists have started to conduct the Annual Consultation on the Likelihood of Coming Earthquakes in the Next Year. This approach has unique scientific and practical merits either as an active response to the social needs in the situation that earthquake prediction research meets many difficulties, or as a real forward prediction test persistently conducted for 1/3 century. It is a pity that such an approach has not been well-known by international seismological community, and the scientific merits of such an endeavor is sometimes regrettably underestimated.展开更多
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...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. <strong>Patients and Method:</strong> 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. <strong>Results:</strong> 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>i.e. </i> 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. <strong>Conclusion:</strong> 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.展开更多
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 midwif...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.展开更多
The purpose of the present research is to develop and validate an instrument for supervision in phone consultation. Literature review and focus group discussion in the first stage led to the extraction of twenty items...The purpose of the present research is to develop and validate an instrument for supervision in phone consultation. Literature review and focus group discussion in the first stage led to the extraction of twenty items for the supervision scale. After the initial administration and the group work of the specialized team and upon receiving the feedback, the repetitive and overlapping items were deleted and ten important items were selected. Finally, the instrument was administered on 499 consolers of phone consultation in 19 provinces of Iran, consisted of male and female individuals cooperating in the counselor’s voice. The consolers were trained and assessed by 96 supervisors. The supervisors consisted of male and female supervisors introduced as supervisors by the State Welfare Organization of Iran in different provinces all over the country. This study was conducted in State Welfare Organization of Iran. The exploratory factor analysis on the supervision scale revealed two dimensions: therapeutic alliance and intervention. The result showed the supervision scale was a valid and reliable instrument for assessing the consultation process in the semi-structured model of phone consultation. The finding is in line with previous studies in terms of therapeutic alliance, intervention in the semi-structured model of phone consultation.展开更多
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 ...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.展开更多
Introduction: Internet has become an increasingly popular source of reference for patients to learn about their medical problems. It is easily accessible, and a large number of uncensored information is available onli...Introduction: Internet has become an increasingly popular source of reference for patients to learn about their medical problems. It is easily accessible, and a large number of uncensored information is available online written from various sources and perspectives. However, the role of internet and its impact on patient’s care and understanding of the disease remains unclear. The purpose of this study is to evaluate the role and effect of internet use for patients seeking consultation for hip and knee arthritis. More specifically, the relationship between patient’s education level, internet use, motives for doing background readings, perception of internet information, and reactions to the available information will be studied. Method: Patients seeking orthopaedic consultation for knee or hip arthritis at the Toronto Western Hospital were identified and invited to fill out a questionnaire on their first visit. The questionnaire was designed to assess the patients’ pre-consultation reading habits, their use of internet, and their reaction to what they have read on the internet. The questionnaire also included questions about the respondent’s background.Results: In comparing patients holding college/university degree (CU) with patients having no college/university education (NoCU), the CU group were associated with increased internet use (CU vs. NoCU: 71.0% vs. 48.3%;p 0.01) and background reading (CU vs. NoCU: 82.2% vs. 17.8%;p 0.001) prior to consultation;fewer incidence of anxiety following internet use (CU vs. NoCU: 29.9% vs. 53.6%;p 0.05);and higher rates of decisions influenced by internet use (CU vs. NoCU: 20.8% vs. 3.6%, p 0.05). Internet users demonstrated a higher confidence in gathering and understanding medical information (Internet users vs. non-internet users: 6.59 ± 2.05 vs. 5.03 ± 2.78;p 0.001) and rated the accuracy of information on internet at 7.18 ± 2.01 (max = 10). Conclusion: Internet use can influence patient’s treatment decision, anxiety level, and understanding of their disease. Caregivers must recognize the growing trend of internet use and should counsel and educate their patients appropriately based on what they have read to help them accurately appreciate the nature of their disease.展开更多
Aim: Nurses must develop good problem-solving skills (PSS) to work in the complex health care environment. This study explored PHNs’ use of analogy in PSS development. The purposes of the study were to clarify how PS...Aim: Nurses must develop good problem-solving skills (PSS) to work in the complex health care environment. This study explored PHNs’ use of analogy in PSS development. The purposes of the study were to clarify how PSS developed in one area (i.e., mental health) could be applied to another area (i.e., maternal health) and whether new PSS could develop in response to PSS gained in another area. Methods: A multiple case study was conducted using interviews. We interviewed 27 consultations from eight Japanese PHNs who consulted in mental health departments before transferring to maternal health departments. The data on how PHNs applied PSS in the selection, mapping, evaluation, and learning stages of the analogy process were extracted from transcribed interviewed data and compared. Results: PHNs provided 59 PSS used in 27 consultations. All PHNs applied past mental health PSS to solve new problems in maternal health. They tended to select past PSS based on structural similarity and to apply PSS via low-level abstraction in serious situations or preventively to avoid causing the current situation to worsen. Notably, PHNs developed maternal health PSS by using past mental health PSS;these new PSS were derived through analogy from various failures and successes. Conclusions: PSS developed in one area can be applied in another area, and new PSS can develop through applying these previous PSS. Identification of structural similarities and preventive analogies must be included in nursing education, especially for nurses working in public health fields.展开更多
In this paper, on the basis of the analysis of the current situation of the mine floor flood and the consultation system study, the overall design and structure, specially, the mechanism of many kinds of method for ma...In this paper, on the basis of the analysis of the current situation of the mine floor flood and the consultation system study, the overall design and structure, specially, the mechanism of many kinds of method for making a strategic decision and reasoning of the system of prevention and control of mine floor flood are introduced. The applied examples are given at last.展开更多
Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the man...Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the management of these conditions and the context of chronic insecurity in our country. In Kayes, there is no data related to the first consultations of patients with the nephrologist, hence the interest of this study, which aimed to describe the epidemiological and clinical characteristics of patients undergoing a first nephrological consultation in Kayes hospital. Materials and methods: This was a retrospective, descriptive study conducted from January 1 to December 31, 2020 at the nephrology unit of the Fousseyni DAOU hospital in Kayes. All patients received for nephrological consultation for whom a medical record was made were included. The following data were collected and analyzed: the specialty of the medical referent, the reason for consultation, sociodemographic characteristics and the renal assessment of patients. Patients who consulted for non-nephrological pathologies and those who had no medical record were not included. Results: We collected the records of 346 patients, composed of 180 (52%) women and 166 (48%) men, i.e. a sex ratio of 0.92. The age group [20 - 40 years] was the most represented, 107 cases or 30.9%, with a mean age of 48.84 ± 21.33 years and extremes of 1 and 90 years. Housewives were the most consulted population, 149 cases (41.33%). Patients consulted more between the months of January and February, 116 cases (33.5%), this period was followed by the months of October-December, July-September and April-June with respectively 94 cases (27.2%), 76 cases (22.0%) and 60 cases (17.3%). The patients were referred by the general practitioner in 59.5% (209 cases), specialist doctor, 26.0% (90 cases). The patients came mainly from hospital practitioners, 172 cases (49.7%), private clinic and practice 81 cases (23.4%), community health center (CSCOM), 69 cases (19.9%). The main reasons for consultation were hypercreatinemia 205 cases (59.2%), low back pain 46 cases (13.3%) and edematous syndrome 16 cases (4.6%). The mean blood pressure was 140/80 mmHg with extremes of 70 and 240 mmHg for systolic and 40 and 160 mmHg for diastolic. Mean creatinine was 660.53 μmol/l ± 821.311 with extremes of 46 and 5447 μmol/l. Patients transferred from the emergency department had a creatinine level above 700 μmol/l in 41.1% (39) of cases (p = 0.003 Person’s Chi-square = 8643 ddl = 1). Among the 316 patients who had a blood count, anemia was found in 221 (69.9%) and the mean hemoglobin level was 9.61 g/dl ± 3.11 with extremes of 1.70 g/dl and 19.56 g/dl. The diagnostic hypotheses evoked were acute renal failure (124 cases, i.e. 38.5%), chronic renal failure (81 cases, i.e. 23.7%). Conclusion: Primary nephrological consultation is more solicited by general practitioners. The consultations, often in the emergency room, were motivated by significant hypercreatinemia. Awareness of the nursing staff, the patients and the political authorities are necessary to encourage nephrological consultations at an early stage of the renal disease.展开更多
文摘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.
文摘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.
基金This work was supported by the Humanities and Social Science Fund of Ministry of Education of China(No.20YJA630009)Shandong Natural Science Foundation of China(No.ZR2022MG002).
文摘This study delves into the formation dynamics of alliances within a closed-loop supply chain(CLSC)that encom-passes a manufacturer,a retailer,and an e-commerce platform.It leverages Stackelberg game for this exploration,contrasting the equilibrium outcomes of a non-alliance model with those of three differentiated alliance models.The non-alliance model acts as a crucial benchmark,enabling the evaluation of the motivations for various supply chain entities to engage in alliance formations.Our analysis is centered on identifying the most effective alliance strategies and establishing a coordination within these partnerships.We thoroughly investigate the consequences of diverse alliance behaviors,bidirectional free-riding and cost-sharing,and the resultant effects on the optimal decision-making among supply chain actors.The findings underscore several pivotal insights:(1)The behavior of alliances within the supply chain exerts variable impacts on the optimal pricing and demand of its members.In comparison to the non-alliance(D)model,the manufacturer-retailer(MR)and manufacturer-e-commerce platform(ME)alliances significantly lower both offline and online resale prices for new and remanufactured goods.This adjustment leads to an enhanced demand for products via the MR alliance’s offline outlets and the ME alliance’s online platforms,thereby augmenting the profits for those within the alliance.Conversely,retailer-e-commerce platform(ER)alliance tends to increase the optimal retail price and demand across both online and offline channels.Under specific conditions,alliance behavior can also increase the profits of non-alliance members,and the profits derived through alliance channels also exceed those from non-alliance channels.(2)The prevalence of bidirectional free-riding behavior largely remains constant across different alliance configurations.Across these models,bidirectional free-riding typically elevates the equilibrium prices in offline channel while negatively affecting the equilibrium prices in other channel.(3)The effect of cost-sharing shows relative uniformity across the various alliance models.Across all configurations,cost-sharing tends to reduce the manufacturer’s profits.Nonetheless,alliances initiated by the manufacturer can counteract these negative impacts,providing a strategic pathway to bolster CLSC profitability.
文摘Ghanaian construction projects encounter a number of challenges, including low health, safety, and environmental requirements, poor performance, and time and cost overruns. To provide value for money (VFM) on government infrastructure projects in Ghana, this research assesses the roles of project consultants, specifically architects and quantity surveyors, and highlights important obstacles. A cross-sectional survey design involving architects and quantity surveyors yielded a 96% response rate after 100 questionnaires were distributed. Consultants’ responsibilities also include monitoring standards compliance, providing advice on delays, controlling budgets, and advising on project completion dates. Difficulties encompass a lack of promptness in decision-making, unethical conduct, political pressure, and inadequate focus on contract administration and construction audits. Project urgency, longevity, political clout, timely decision-making, and team experience are important variables that impact VFM. Policy makers and construction management practitioners should take note of the implications for Ghana’s public infrastructure projects.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc012)~~
文摘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, and 37 consultations were completed in 2016. 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 in 2016 formally(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 were 103 physicians 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 were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% 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).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.
文摘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.
文摘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.
文摘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.
文摘<strong>Introduction</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><strong>:</strong></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> 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. </span><b><span style="font-family:Verdana;">Materials</span></b> <b><span style="font-family:Verdana;">and</span></b> <b><span style="font-family:Verdana;">Methods</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 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 in</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">i</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">tial 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). </span><b><span style="font-family:Verdana;">Results</span></b></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> 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) respectiv</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">e</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">ly 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%). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> 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 </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">on</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> the value of early diagnosis of breast cancer. Also, health system should be improved to enable early diagnosis and treatment of this affection.</span></span></span>
文摘Since the 1970s, Chinese seismologists have started to conduct the Annual Consultation on the Likelihood of Coming Earthquakes in the Next Year. This approach has unique scientific and practical merits either as an active response to the social needs in the situation that earthquake prediction research meets many difficulties, or as a real forward prediction test persistently conducted for 1/3 century. It is a pity that such an approach has not been well-known by international seismological community, and the scientific merits of such an endeavor is sometimes regrettably underestimated.
文摘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. <strong>Patients and Method:</strong> 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. <strong>Results:</strong> 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>i.e. </i> 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. <strong>Conclusion:</strong> 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.
文摘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.
文摘The purpose of the present research is to develop and validate an instrument for supervision in phone consultation. Literature review and focus group discussion in the first stage led to the extraction of twenty items for the supervision scale. After the initial administration and the group work of the specialized team and upon receiving the feedback, the repetitive and overlapping items were deleted and ten important items were selected. Finally, the instrument was administered on 499 consolers of phone consultation in 19 provinces of Iran, consisted of male and female individuals cooperating in the counselor’s voice. The consolers were trained and assessed by 96 supervisors. The supervisors consisted of male and female supervisors introduced as supervisors by the State Welfare Organization of Iran in different provinces all over the country. This study was conducted in State Welfare Organization of Iran. The exploratory factor analysis on the supervision scale revealed two dimensions: therapeutic alliance and intervention. The result showed the supervision scale was a valid and reliable instrument for assessing the consultation process in the semi-structured model of phone consultation. The finding is in line with previous studies in terms of therapeutic alliance, intervention in the semi-structured model of phone consultation.
文摘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.
文摘Introduction: Internet has become an increasingly popular source of reference for patients to learn about their medical problems. It is easily accessible, and a large number of uncensored information is available online written from various sources and perspectives. However, the role of internet and its impact on patient’s care and understanding of the disease remains unclear. The purpose of this study is to evaluate the role and effect of internet use for patients seeking consultation for hip and knee arthritis. More specifically, the relationship between patient’s education level, internet use, motives for doing background readings, perception of internet information, and reactions to the available information will be studied. Method: Patients seeking orthopaedic consultation for knee or hip arthritis at the Toronto Western Hospital were identified and invited to fill out a questionnaire on their first visit. The questionnaire was designed to assess the patients’ pre-consultation reading habits, their use of internet, and their reaction to what they have read on the internet. The questionnaire also included questions about the respondent’s background.Results: In comparing patients holding college/university degree (CU) with patients having no college/university education (NoCU), the CU group were associated with increased internet use (CU vs. NoCU: 71.0% vs. 48.3%;p 0.01) and background reading (CU vs. NoCU: 82.2% vs. 17.8%;p 0.001) prior to consultation;fewer incidence of anxiety following internet use (CU vs. NoCU: 29.9% vs. 53.6%;p 0.05);and higher rates of decisions influenced by internet use (CU vs. NoCU: 20.8% vs. 3.6%, p 0.05). Internet users demonstrated a higher confidence in gathering and understanding medical information (Internet users vs. non-internet users: 6.59 ± 2.05 vs. 5.03 ± 2.78;p 0.001) and rated the accuracy of information on internet at 7.18 ± 2.01 (max = 10). Conclusion: Internet use can influence patient’s treatment decision, anxiety level, and understanding of their disease. Caregivers must recognize the growing trend of internet use and should counsel and educate their patients appropriately based on what they have read to help them accurately appreciate the nature of their disease.
文摘Aim: Nurses must develop good problem-solving skills (PSS) to work in the complex health care environment. This study explored PHNs’ use of analogy in PSS development. The purposes of the study were to clarify how PSS developed in one area (i.e., mental health) could be applied to another area (i.e., maternal health) and whether new PSS could develop in response to PSS gained in another area. Methods: A multiple case study was conducted using interviews. We interviewed 27 consultations from eight Japanese PHNs who consulted in mental health departments before transferring to maternal health departments. The data on how PHNs applied PSS in the selection, mapping, evaluation, and learning stages of the analogy process were extracted from transcribed interviewed data and compared. Results: PHNs provided 59 PSS used in 27 consultations. All PHNs applied past mental health PSS to solve new problems in maternal health. They tended to select past PSS based on structural similarity and to apply PSS via low-level abstraction in serious situations or preventively to avoid causing the current situation to worsen. Notably, PHNs developed maternal health PSS by using past mental health PSS;these new PSS were derived through analogy from various failures and successes. Conclusions: PSS developed in one area can be applied in another area, and new PSS can develop through applying these previous PSS. Identification of structural similarities and preventive analogies must be included in nursing education, especially for nurses working in public health fields.
文摘In this paper, on the basis of the analysis of the current situation of the mine floor flood and the consultation system study, the overall design and structure, specially, the mechanism of many kinds of method for making a strategic decision and reasoning of the system of prevention and control of mine floor flood are introduced. The applied examples are given at last.
文摘Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the management of these conditions and the context of chronic insecurity in our country. In Kayes, there is no data related to the first consultations of patients with the nephrologist, hence the interest of this study, which aimed to describe the epidemiological and clinical characteristics of patients undergoing a first nephrological consultation in Kayes hospital. Materials and methods: This was a retrospective, descriptive study conducted from January 1 to December 31, 2020 at the nephrology unit of the Fousseyni DAOU hospital in Kayes. All patients received for nephrological consultation for whom a medical record was made were included. The following data were collected and analyzed: the specialty of the medical referent, the reason for consultation, sociodemographic characteristics and the renal assessment of patients. Patients who consulted for non-nephrological pathologies and those who had no medical record were not included. Results: We collected the records of 346 patients, composed of 180 (52%) women and 166 (48%) men, i.e. a sex ratio of 0.92. The age group [20 - 40 years] was the most represented, 107 cases or 30.9%, with a mean age of 48.84 ± 21.33 years and extremes of 1 and 90 years. Housewives were the most consulted population, 149 cases (41.33%). Patients consulted more between the months of January and February, 116 cases (33.5%), this period was followed by the months of October-December, July-September and April-June with respectively 94 cases (27.2%), 76 cases (22.0%) and 60 cases (17.3%). The patients were referred by the general practitioner in 59.5% (209 cases), specialist doctor, 26.0% (90 cases). The patients came mainly from hospital practitioners, 172 cases (49.7%), private clinic and practice 81 cases (23.4%), community health center (CSCOM), 69 cases (19.9%). The main reasons for consultation were hypercreatinemia 205 cases (59.2%), low back pain 46 cases (13.3%) and edematous syndrome 16 cases (4.6%). The mean blood pressure was 140/80 mmHg with extremes of 70 and 240 mmHg for systolic and 40 and 160 mmHg for diastolic. Mean creatinine was 660.53 μmol/l ± 821.311 with extremes of 46 and 5447 μmol/l. Patients transferred from the emergency department had a creatinine level above 700 μmol/l in 41.1% (39) of cases (p = 0.003 Person’s Chi-square = 8643 ddl = 1). Among the 316 patients who had a blood count, anemia was found in 221 (69.9%) and the mean hemoglobin level was 9.61 g/dl ± 3.11 with extremes of 1.70 g/dl and 19.56 g/dl. The diagnostic hypotheses evoked were acute renal failure (124 cases, i.e. 38.5%), chronic renal failure (81 cases, i.e. 23.7%). Conclusion: Primary nephrological consultation is more solicited by general practitioners. The consultations, often in the emergency room, were motivated by significant hypercreatinemia. Awareness of the nursing staff, the patients and the political authorities are necessary to encourage nephrological consultations at an early stage of the renal disease.