scholarly journals Out-patient care for people with learning disability and epilepsy: evaluating the audit process

1995 ◽  
Vol 19 (11) ◽  
pp. 686-688 ◽  
Author(s):  
Helen Chubb ◽  
Michael Kerr ◽  
Joseph Joyce
Keyword(s):  
Patient Care ◽  
Learning Disability ◽  
General Practitioners ◽  
Seizure Frequency ◽  
Seizure Type ◽  
Medical Audit ◽  
Audit Process ◽  
Audit Standards

The notes of 24 individuals attending a clinic for people with learning disability and epilepsy were reviewed for all visits in the year preceding and following the Implementation of medical audit standards for out-patient review. There was no deterioration in any standard. A significant improvement was seen in recording of seizure frequency by seizure type, legibility of signatures, regular letters to general practitioners and the recording of seizure type and frequency in these. Medical audit can improve standards in epilepsy care, though its influence on outcome is not known.

scholarly journals Attitudes to and experience of disease management programs in primary care—an exploratory survey of general practitioners in Germany

2021 ◽  
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Patient Care ◽  
General Practitioners ◽  
Linear Regression Analysis ◽  
Chronically Ill ◽  
Disease Management Programs ◽  
Federal States ◽  
Set Up ◽  
Chronically Ill Patients

Summary Background Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement. Methods A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire. Results In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care. Conclusion Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.

Somatoform disorders: A help or hindrance to good patient care?

2004 ◽  
Vol 184 (6) ◽  
pp. 465-467 ◽  
Author(s):  
Michael Sharpe ◽  
Richard Mayou
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
General Practitioners ◽  
Somatoform Disorders ◽  
Somatoform Disorder ◽  
Good Patient ◽  
Specific Category ◽  
Good Patient Care ◽  
Almost All ◽  
Issue Reports

The paper by de Waal and colleagues (2004, this issue) reports on the prevalence of somatoform disorders in Dutch primary care. They found that at least one out of six patients seen by general practitioners could be regarded as having a somatoform disorder, almost all in the non-specific category of undifferentiated somatoform disorder. The prevalence of the condition has major implications for medical services but what does this diagnosis mean? Is receiving a diagnosis of somatoform disorder of any benefit to the patient? Does it help the doctor to provide treatment?

Medical Audit to Improve the Quality of Patient Care in Thoracic Surgery

2021 ◽  
Vol 31 (4) ◽  
pp. 497-508
Author(s):  
Farid M. Shamji ◽  
Joel Cooper ◽  
Gilles Beauchamp
Keyword(s):  
Thoracic Surgery ◽  
Patient Care ◽  
Medical Audit ◽  
Quality Of Patient Care

scholarly journals Physician's Burnout and the COVID-19 Pandemic—A Nationwide Cross-Sectional Study in Austria

2021 ◽  
Vol 12 ◽  
Author(s):  
Ilsemarie Kurzthaler ◽  
Georg Kemmler ◽  
Bernhard Holzner ◽  
Alex Hofer
Keyword(s):  
Psychological Distress ◽  
Patient Care ◽  
General Practitioners ◽  
Statistical Significance ◽  
Demographic Data ◽  
Brief Symptom Inventory ◽  
Stress Factors ◽  
Financial Problems ◽  
Cross Sectional ◽  
Self Reporting Questionnaire

Background: The current study assesses the prevalence of burnout and psychological distress among general practitioners and physicians of various specialities, who are not working in a hospital, during the COVID-19 pandemic. Additionally in this context, contributing factors are registered.Materials and Methods: Burnout and psychological distress were assessed with the Copenhagen Burnout Inventory (CBI) and the Brief Symptom Inventory (BSI-18). A newly developed self-reporting questionnaire was used to evaluate demographic data and pandemic-associated stress factors.Results: 252 general practitioners and 229 private practice physicians provided sufficient responses to the outcome variables for analysis. The prevalence of clinically relevant psychological distress was comparable between groups (12.4 vs. 9.2%). A larger proportion of general practitioners than specialists had intermediate (43.8 vs. 39.9%) or high burnout (26.9 vs. 22.0%) without reaching statistical significance for either category. When combining study participants with intermediate and high levels of burnout, the group difference attained significance (70.7 % vs. 61.9%).Conclusion: Our findings provide evidence that practicing physicians are at high risk of burnout in the context of the pandemic. Being single (standardized beta = 0.134), financial problems (beta = 0.136), and facing violence in patient care (beta = 0.135) were identified as significant predictors for psychological distress. Burnout was predicted by being single (beta = 0.112), financial problems (beta= 0.136), facing violence in patient care (beta = 0.093), stigmatization because of treatment of SARS-CoV-2-positive patients (beta = 0.150), and longer working hours during the pandemic (beta = 0.098).

scholarly journals Pilot study to build capacity for family medicine with abbreviated, low-cost training programme with minimal impact on patient care for a cohort of 84 general practitioners caring for Palestinian refugees in Jordan

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028240 ◽  
Author(s):  
Amjad Al Shdaifat ◽  
Therese Zink
Keyword(s):  
Primary Care ◽  
Patient Care ◽  
General Practitioners ◽  
Clinical Skills ◽  
Low Cost ◽  
Training Programme ◽  
Ambulatory Setting ◽  
Secondary Outcome ◽  
Intervention Programme ◽  
Minimal Impact

PurposeStudies document that primary care improves health outcomes and controls costs. In regions of the world where primary care is underdeveloped, building capacity is essential. Most capacity building programmes are expensive and take physicians away from their clinical settings. We describe a programme created, delivered and evaluated from 2013 to 2014 in Jordan.DesignCohort study.SettingPhysicians providing primary care in the United Nations Relief and Works Agency for Palestine Refugees clinics in Jordan.ParticipantsEighty-four general practitioners (GPs) were invited to participate and completed the training and evaluation. GPs are physicians who have a license to practice medicine after completing medical school and a 1 year hospital-based rotating internship. Although GPs provide care in the ambulatory setting, their hospital-based education provides little preparation for delivering ambulatory primary care.Intervention/ProgrammeThis three-stage programme included needs assessment, didactics and on-the-job coaching. First, the learning needs and baseline knowledge of the trainees were assessed and the findings guided curriculum development. During the second stage, 48 hours of didactics covered topics such as communications skills and disease management. The third stage was delivered one on one in the trainee’s clinical setting for a 4 to 6-hour block. The first, middle and final patient interactions were evaluated.Primary and secondary outcome measuresPreknowledge and postknowledge assessments were compared. The clinical checklist, developed for the programme, assessed eight domains of clinical skills such as communication and history taking on a five-point Likert scale during the patient interaction.ResultsPreknowledge and postknowledge assessments demonstrated significantly improved scores, 46% to 81% (p<0.0001). Trainee’s clinical checklist scores improved over the assessment intervals. Satisfaction with the training was high.ConclusionThis programme is a potential model for building primary care capacity at low cost and with little impact on patient care that addresses both knowledge and clinical skills on the job.

scholarly journals The role of the psychiatrist in learning disability

1994 ◽  
Vol 18 (4) ◽  
pp. 205-206 ◽  
Author(s):  
Sarah H. Bernard ◽  
Rosalind E. Bates
Keyword(s):  
Primary Care ◽  
Learning Disability ◽  
General Practitioners ◽  
Postal Questionnaire ◽  
Further Education ◽  
Care Level ◽  
Primary Care Level ◽  
Lack Of Knowledge

This study assessed, by postal questionnaire, how the role of the psychiatrist in learning disability is perceived by general practitioners. One hundred and forty-six GPs were questioned on various aspects of assessment and management that the psychiatrist in learning disability might be involved with; 43.5% of questionnaires were returned. The results indicated that confusion continues. The psychiatrist was perceived as having a global role in the care of this group of patients with lack of knowledge of community teams for learning disability being evident. Further education at a primary care level is indicated.

TP3-3 Why do some patients fail to respond to VNS? – a retrospective analysis of cardiac based seizure detection (CBSD) therapy

2019 ◽  
Vol 90 (3) ◽  
pp. e18.3-e18
Author(s):  
B Wysota ◽  
S Samarasekera ◽  
P Hamilton ◽  
I Soryal
Keyword(s):  
Learning Disability ◽  
Poor Response ◽  
Seizure Detection ◽  
Seizure Type ◽  
Poor Responders ◽  
Structural Abnormality ◽  
Therapeutic Level ◽  
Seizure Reduction ◽  
Potential Factors ◽  
Patients With Epilepsy

ObjectivesTo identify predictors of poor response to cardiac based seizure detection (CBSD) VNS therapy.DesignData was collected retrospectively for patients with epilepsy who had VNS Aspire SR implanted between June 2014 and June 2017. 51 patients who reached a therapeutic level of stimulation were included. We compared those who achieved significant seizure reduction (at least 50%) with the remainder to identify potential factors predicting response.Subjects51 patients achieving therapeutic stimulation (1.5mA) with the VNS Aspire SR.MethodsWe reviewed patients’ electronic records over the period between June 2014 and June 2018.Results32 (63%) patients achieved significant seizure reduction. The following factors applied equally to both responders and non-responders: patient age, duration of epilepsy prior to VNS insertion, seizure type, the presence of a causative structural abnormality and the presence of a carer. Co-existing learning disability and/or non-epileptic attacks were commoner among poor responders. Polytherapy (3 or more AEDs) and non-compliance with medical treatment were also commoner among the poor responders; none of these factors was statistically significant.ConclusionsFactors potentially predicting response to resective surgery (including patients’ age and duration of epilepsy) do not necessarily predict response to VNS therapy. The presence of a learning disability and the extent of seizure refractoriness may influence response to VNS therapy; a larger study is needed to assess their significance.

Updating Audit Standard—Enabling Audit Data Analysis

2013 ◽  
Vol 27 (1) ◽  
pp. 325-331 ◽  
Author(s):  
William R. Titera
Keyword(s):  
Data Analysis ◽  
Audit Process ◽  
Private Company ◽  
Continuous Auditing ◽  
External Auditors ◽  
Financial Statement Audit ◽  
Audit Data ◽  
Depth Analysis ◽  
Audit Standard ◽  
Audit Standards

ABSTRACT This paper highlights the emerging role of data analysis on the financial statement audit and its value throughout the audit process, particularly in providing audit evidence. It raises the issue of needed revisions to the Audit Standards, whether for public or private company audits, and illustrates how certain of the current Audit Standards inhibit the external auditors' use of enhanced data analysis and continuous auditing techniques. While this whitepaper identifies a few audit standards that could be revised in light of current technological capabilities, it does not purport to address all needed revisions. Rather, it recommends that a more in-depth analysis be undertaken to develop needed guidance, as well as a list of recommended changes to the standards.

scholarly journals Rates and Predictors of Seizure Freedom With Vagus Nerve Stimulation for Intractable Epilepsy

Neurosurgery ◽  
2015 ◽  
Vol 79 (3) ◽  
pp. 345-353 ◽  
Author(s):  
Dario J. Englot ◽  
John D. Rolston ◽  
Clinton W. Wright ◽  
Kevin H. Hassnain ◽  
Edward F. Chang
Keyword(s):  
Vagus Nerve ◽  
Seizure Frequency ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Intractable Epilepsy ◽  
Progressive Increase ◽  
Seizure Type ◽  
Seizure Freedom ◽  
Outcome Registry ◽  
Over Time

AbstractBACKGROUND:Neuromodulation-based treatments have become increasingly important in epilepsy treatment. Most patients with epilepsy treated with neuromodulation do not achieve complete seizure freedom, and, therefore, previous studies of vagus nerve stimulation (VNS) therapy have focused instead on reduction of seizure frequency as a measure of treatment response.OBJECTIVE:To elucidate rates and predictors of seizure freedom with VNS.METHODS:We examined 5554 patients from the VNS therapy Patient Outcome Registry, and also performed a systematic review of the literature including 2869 patients across 78 studies.RESULTS:Registry data revealed a progressive increase over time in seizure freedom after VNS therapy. Overall, 49% of patients responded to VNS therapy 0 to 4 months after implantation (≥50% reduction seizure frequency), with 5.1% of patients becoming seizure-free, while 63% of patients were responders at 24 to 48 months, with 8.2% achieving seizure freedom. On multivariate analysis, seizure freedom was predicted by age of epilepsy onset &gt;12 years (odds ratio “OR”, 1.89; 95% confidence interval “CI”, 1.38-2.58), and predominantly generalized seizure type (OR, 1.36; 95% CI, 1.01-1.82), while overall response to VNS was predicted by nonlesional epilepsy (OR, 1.38; 95% CI, 1.06-1.81). Systematic literature review results were consistent with the registry analysis: At 0 to 4 months, 40.0% of patients had responded to VNS, with 2.6% becoming seizure-free, while at last follow-up, 60.1% of individuals were responders, with 8.0% achieving seizure freedom.CONCLUSION:Response and seizure freedom rates increase over time with VNS therapy, although complete seizure freedom is achieved in a small percentage of patients.

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