Journal of evaluation in clinical practice
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Radiologic imaging is an essential component in the workup of many patients with neuro-otologic conditions. However, patients often present for consultation with a neurotologist without the imaging that they have already undergone as part of their workup by a referring clinician. This disconnect causes frustration for clinicians and possible delays in care for patients. Anecdotally, clinicians felt that patients who had contact with clinic coordinators before their appointment were more likely to have their prior imaging available for review at the time of their initial consultation. ⋯ Improved communication and tracking of image receipt in clinics receiving many referrals saves physicians' time, reduces frustration and cuts down on the overall administrative burden following patients' appointments.
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RATIONALE, AIMS AND OBJECTIVES: Myotonic dystrophy type 1 (DM1) is a progressive multisystem disorder that requires a special focus on the delivery of health and rehabilitation. The aim of the study was to identify the needs and interventions in patients with DM1 referred to a national rehabilitation hospital and to illustrate the needs and interventions in relation to predefined subgroups of disease classification. ⋯ All subgroups of patients with DM1 had a substantial number of needs and interventions related to coordinating and navigating within the healthcare system. The subgroup of patients with congenital DM1 had the most needs and interventions compared to the other subgroups.
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The aim of this study was to describe the experiences of parents handling oral anticancer drugs in a home setting. ⋯ Parents need to be provided with accurate, timely, nonconflicting and repeated information-in different forms and in their mother tongue-on how to handle oral anticancer drugs at home.
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Observational Study
Primary care access to radiology: Characteristics of trauma patients referred to the emergency department.
Low-urgent Emergency Department (ED) attendances are a known contributing factor to ED crowding. In the Netherlands, general practitioners (GPs) have direct access to radiology facilities during office hours. Patients with radiographically confirmed traumatic injuries are subsequently referred to the ED. We analysed these ED trauma patients' characteristics, provided treatments and ED discharge diagnoses to identify the possibility of alternative care pathways. ⋯ Most patients presented with low acuity injuries and often with a notable delay to the ED. This suggests that the majority of these patients do not necessarily need ED treatment, which may provide an opportunity to counter ED crowding.
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Generalists manage a broad range of biomedical and biographical knowledge as part of each clinical encounter, often in multiple encounters over time. The sophistication of this broad integrative work is often misunderstood by those schooled in reductionist or constructivist approaches to evidence. There is a need to describe the practical and philosophically robust ways that understanding about the whole person is formed. In this paper we describe first principles of generalist approaches to knowledge formation in clinical practice. We name the Craft of Generalism. ⋯ Naming the Craft of Generalism defines the generalist gaze and protects generalism from the colonization of a narrowed medical gaze that excludes all but reductionist evidence or constructivist experience. Defining the Craft of Generalism enables clear teaching of the sophisticated skills and attitudes of the generalist clinician. These philosophically robust principles encourage and defend the use of generalist approaches to knowledge in settings across the community - including health policy, education, and research.