Background. A demanda por cuidados médicos especializados vem aumentando em todo o mundo. Analisamos uma iniciativa de telemedicina para reduzir o tempo entre encaminhamento e consulta especializada e o número de pacientes na fila de espera. Métodos. Um estudo retrospectivo com controles contemporâneos foi realizado entre junho de 2014 a julho de 2016. As especialidades selecionadas foram incluídas em uma intervenção de telemedicina e comparadas com as especialidades controle reguladas de forma padrão. Os pacientes de intervenção foram combinados com um conjunto aleatório de controles (proporção 1: 1) por semestre e ano de inclusão na lista de espera e pelo índice de demanda e oferta de consultas especializadas (número de pacientes na fila de espera em junho de 2014 dividido pela média de consultas médicas especializadas disponibilizadas durante os 25 meses que compõem o período de análise). A intervenção de telemedicina incluiu o desenvolvimento de protocolos de referência e classificação de risco de pacientes na fila de espera. O tempo de espera para a consulta presencial e a magnitude da diminuição do número de pacientes na fila no final da observação foram os desfechos primários. Resultados. Nefrologia, pneumologia, urologia, neurologia, neurocirurgia e reumatologia foram selecionados para a intervenção, para um total de 50.185 pacientes (idade média: 51,5 anos) versus 50,124 pacientes controles (idade média: 52,2 anos). O tempo médio para o agendamento de consultas foi de 583,5 dias no grupo de intervenção versus 599,8 dias nos controles (p <0,001). O volume da lista de espera diminuiu 61,4% no grupo de intervenção e 53,2% no grupo controle 13 (<0,001). Para pacientes de alto risco (grupo de intervenção apenas), o tempo médio entre encaminhamento e consultas foi de 235,43 dias. Conclusões. A intervenção de telemedicina foi eficaz para diminuir o tempo de espera, especialmente para indivíduos de alto risco, e número de pacientes em espera para consultas médicas especializadas, o que sinaliza um efeito positivo sobre a eficiência do sistema de saúde, com redução de tempo e custos de deslocamentos, além de potencializar a prevenção quaternária ao prevenir consultas desnecessárias com médicos especilaistas, por meio do melhor manejo dos médicos de atenção primária. / Background. The demand for specialist care is increasing worldwide. We tested a telemedicine initiative to reduce the time between referral and specialist appointment and the number of waitlisted patients. Methods. A retrospective trial with contemporaneous controls was conducted between June 2014-July 2016. Selected specialties were included in a telemedicine intervention and compared to control specialties covered by the usual gatekeeping program. Intervention patients were matched to a random set of controls (1:1 ratio) by semester and year of inclusion in the waiting list and by the specialty demand to supply ratio (number of waitlisted patients in June 2014 divided by the mean number of appointment slots during the 25 months comprising the period of analysis). The telemedicine intervention encompassed development of referral protocols and risk classification of waitlisted patients. Waiting time to face-to-face consultation and magnitude of decrease in the number of waitlisted patients at the end of the observation were defined as primary outcomes. Results. Nephrology, pulmonology, urology, neurology, neurosurgery, and rheumatology were selected for the intervention, for a total 50,185 patients (mean age: 51.5 years) vs. 50,124 patients controls (mean age: 52.2 years). Mean referralto- appointment time was 583.5 days in the intervention group vs. 599.8 days in controls (p<0.001). Waitlist volume decreased 61.4% in the intervention group and 53.2% in the control group (<0.001). For high-risk patients (intervention group only), mean time between referral and appointments was 235.43 days. 15 Conclusions. The telemedicine intervention was effective to decrease wait time, especially for high-risk individuals, and number of waitlisted patients, which signal a positive effect of e-consultations on the knowledge of primary care physicians, reducing time and travel costs and enhancing a quaternary prevention and avoiding unnecessary consultations. / Telemedicina

I Malmö stads översiktsplan fastslås en ambition om att i högre grad involvera medborgare i planeringen för att göra staden mer jämlik och socialt hållbar, samtidigt som planeringen kan bli mer effektiv när planer kan förankras genom att involvera medborgare i ett tidigt skede. Men för att involvera medborgare i planeringen, i ett tidigt stadie, krävs det att det görs ansatser som går utöver de lagliga krav som Plan- och Bygglagen ställer på planförfarandet om medborgerligt demokratiskt inflytande. Denna ansats benämner Malmö stad som fördjupad delaktighet. Men vad som ingår i de ansatser som går utöver lagens krav och möjligheterna för hur medborgare kan påverka planeringen, kan variera från en planprocess till en annan. Hur Malmö stad arbetar med att involvera medborgare med metoder som går utöver lagens krav ämnar denna studie studera. Detta har undersökts med en fallstudie som har studerat ett aktivt planeringsprojekt i Bunkeflostrand i Malmö. Fallstudien har kompletterats med en dokumentstudie samt en intervju som har genomförs med en nyckelaktör i planeringsprojektet, med ansvar för medborgardialog. Denna inhämtade information har sedan analyserats med hjälp av teorier som har sin grund i deliberativ demokratiteori, medborgarmakt, demokratiska innovationer och kommunikativ planeringsteori. Genom denna analys har vi identifierat att medborgare ges en större möjlighet att delta i planprocessen, men att detta inte översätts till att medborgare ges en medbestämmanderätt. Hur medborgares åsikter överförs till planarbetet försvåras av planutformningens teknokratiska natur, vilket innebär att det medborgerliga inflytandet kräver stöd från andra aktörer för att kunna förverkligas. / Malmö municipality’s general plan states an ambition to involve citizens, to a higher degree, in city planning to make the city more equitable and socially sustainable. By involving citizens in planning, it can become more effective when plans are thoroughly anchored with citizens at an early stage. But in order to involve citizens at an early stage in planning, it is necessary for city planning to make efforts that go beyond the legal requirements that Plan- och Bygglagen imposes on the planning procedure for civic democratic influence. This effort is defined in Malmö Municipality’s’ general plan as deepened participation. But what is included in the efforts that go beyond the requirements of the law and the possibilities for how citizens can influence planning can vary from one planning process to another. The purpose of this study is to understand how Malmö Municipality works to involve citizens with methods that go beyond the requirements of the law. This has been investigated with a case study that has examined an active planning project in Bunkeflostrand in Malmö Municipality. The case study has been supplemented by a document study as well as an interview conducted with a key employee in the planning project, responsible for citizen dialogue. This information has then been analyzed with the help of theories based on deliberative democracy theory, citizen power, democratic innovations, and communicative planning theory. Through this analysis, we have identified that citizens are given a greater opportunity to participate in the planning process, but that this is not translated into giving citizens a right of co-decision. How citizens' opinions are transferred to planning work is complicated by the technocratic nature of plan making, which means that civic influence requires support from other stakeholders to be realized.

This study was to investigate the role played by traditional authorities in IDP policy implementation in local municipal councils in the Vhembe District located in Limpopo Province. The specific objectives of this study were to characterise the traditional authority serving in the municipal councils. Traditional leaders serving in municipal councils, the district mayor, local municipal mayors, managers, IDP managers, district and provincial representatives of the House of Traditional Leaders in Limpopo Province were interviewed using semi-structured sets of questionnaire to obtain the required data. The data were entered into an Excel Spreadsheet and subsequently exported into an SPSS for analysis. The results of the study revealed that traditional authority forms an integral part of IDP policy implementation in Vhembe District Municipality. The results further revealed that perceptions of stakeholders vary as to the role played by traditional authorities in the IDP policy implementation process. The results revealed that some traditional leaders agreed that participation in IDP policy implementation (45.5%), involvement (45.2%), the submission of views (41.2%); ward committee meetings (42.8), council IDP policy (90.0%), role (50.0%), submission of proposals (38.7%) and consultation by the municipality (93.2%), were all satisfactorily taking place in the municipality. Furthermore, the results indicated that traditional leaders serving in municipal councils were members of the ruling party (40.0%), aged on average 55.26 years, distributed between 35 and 75 years, and were from extended households of 11.3 members per household, distributed between 3 and 25 members ¯ with an average of 2.4 spouses per traditional leader, distributed between one and five spouses. The majority had attained secondary level education (40.0%), tertiary level education (33.3%) and primary education (26.7%). They showed high experience ranging between 2 to 35 years, and 17.46 years on average as traditional leaders – with a further 7.66 years of experience in the municipal council. The majority make their livelihood by way of compensation from council (73.3%), wages from government as traditional leaders (93.3%), or employment (6.7%). All the traditional leaders own vehicles. The study concluded that the demographic and endowment characteristics of these traditional leaders influence their role in municipal IDP policy implementation. / Thesis (PhD)--University of Pretoria, 2012. / School of Public Management and Administration (SPMA) / unrestricted

Universitäten treten im Zuge der demografischen Wende in einen Wettstreit um Studierende. Fasst man die Universität in diesem Sinne als Unternehmen, Studiengänge als Dienstleistungen und die Studierenden als Kundinnen und Kunden dieser Dienstleistungen auf, rückt die Sicherung und Weiterentwicklung der Qualität des gesamten Studienumfelds in den Mittelpunkt der Betrachtungen. Qualität wird hier in erster Linie als customer satisfaction verstanden, also als Zufriedenheit der Studierenden. Diese wird dabei wesentlich von der Güte von Informations- und Beratungsangeboten beeinflusst. Im vorliegenden Projektbericht stellen wir in diesem Zusammenhang das Nutzungsverhalten und die Zufriedenheit von Studierenden in Bezug auf Beratungs- und Informationsangebote der Universität Leipzig zu verschiedenen Zeitpunkten ihres Studiums dar. Wir beziehen uns dabei im Wesentlichen auf Lehramtsstudierende in verschiedenen Phasen ihres Studiums, greifen aber auch auf eine Vergleichsgruppe von Studienanfängern zurück, die kein Lehramt studieren.

Einleitung: Im Rahmen eines Projekts wird untersucht, ob sich medizinische Laien mit einem neugestalteten internetbasierten Informationssystem besser informieren können, als dieses mit Suchmaschinen und Gesundheitsportalen möglich ist. Die Evaluation eines Systems zur Informationsversorgung von Kopfschmerzpatienten ist nur dann sinnvoll, wenn tatsächlich viele Menschen im deutschsprachigen Raum unter Kopfschmerzen leiden und mit Ihren Beschwerden eher das Internet als einen Arzt konsultieren. Daher wurde in drei Studien die Prävalenz von Kopfschmerzen und die damit verbundene Arztkonsultationsquote untersucht. Methode: Dazu wurden 2000 Versicherte der BARMER Ersatzkasse, ca. 9000 Studenten der Hochschule Bremen und ca. 1000 Studenten der Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik in Tirol, Österreich (UMIT) angeschrieben und gefragt, ob sie unter Kopfschmerzen leiden und wenn ja, ob sie für ihre Kopfschmerzen bereits eine ärztliche Diagnose haben. Insgesamt nahmen 521 Personen an der Untersuchung teil. Ergebnisse: Davon litten 292 Teilnehmer (56 %) unter Kopfschmerzen. Eine ärztliche Diagnose für diese hatten 52 (18 %). Alles in allem zeigt sich damit eine etwas geringere Kopfschmerzprävalenz als in den vorangegangen Studien. Die in der Literatur genannte Arztkonsultationsquote wird bestätigt. Diskussion: Die Auswertung der drei Studien zeigte, dass die Prävalenz von Kopfschmerzen weiterhin hoch und die damit verbundene Arztkonsultationsquote immer noch gering ist. / Introduction: In a project, it is investigated whether a newly designed web-information system can better inform medical laymen than traditional search engines and health portals. The evaluation of a system for providing information to headache patients is only useful when in fact many people suffer from headaches in the German speaking area and if these people with their complaints rather consult the Internet than a practitioner. Therefore, in three studies the prevalence of headache and the associated physician consultation rate was examined. Method: About 9000 students of the University of Applied Sciences Bremen, 2000 insurants of the BARMER, and about 1000 students of the University of Health Sciences, Medical Informatics and technology Tyrol, Austria (UMIT) were asked if they suffer from headaches and if so whether they already have a medical diagnosis. A total of 521 persons participated in the investigation. Results: From headaches suffered 292 (56%) participants. A medical diagnosis for these had 52 (18%). All in all, it shows slightly lower headache prevalence than found in previous studies. The medical consultation rate cited in the literature is confirmed. Discussion: The evaluation of the three studies showed that the prevalence of headache remains high and the associated physician consultation rate is still low.

Bakgrund: Besöken på akutmottagningar för barn i Sverige ökar hela tiden. För att möta detta har allt fler sjukhus börjat använda sig av sjuksköterskebesök. Syfte: Att beskriva barnsjuksköterskans erfarenhet av att självständigt bedöma och behandla sjuka barn på en akutmottagning. Metod: En kvalitativ intervjustudie med induktivt förhållningssätt. Urvalet bestod av elva barnsjuksköterskor med erfarenhet av sjuksköterskebesök. Materialet analyserades med manifest innehållsanalys. Resultat: Barnsjuksköterskans erfarenhet av sjuksköterskebesök visade sig vara positiva. Hen ansåg att sjuksköterskebesök innebar att arbetet blev mer stimulerande och utvecklande. Barnsjuksköterskan hade en betydande uppgift i att barnen kom till rätt vårdnivå både för barnets bästa och för att verksamheten skulle fungera på ett bra sätt. Det fanns potential och vilja att utveckla sjuksköterskebesök på akutmottagning för barn. Slutsats: Sjuksköterskebesök är positivt för barnsjuksköterskan, för att det bidrar till att barnsjuksköterskan utvecklas i sin profession vilket i sin tur skapar arbetsglädje. På grund av sjuksköterskebesök kan barnen som inte är i behov av en läkarbedömning få hjälp snabbare vilket leder till kortare väntetider på akutmottagningarna. / Background: Visits in the Swedish emergency units for children are increasing. In order to meet this, more and more hospitals are using nurse-led consultations. Aim: The purpose of this study was to describe the pediatric nurse´s experience of independently assess and treat children in the emergency department for children. Method: A qualitative interview study with inductive approach. The sample consisted of eleven pediatric nurses with experience of nursing visits. The material was analyzed with manifest content analysis. Results: The pediatric nurse´s experience of nurse-led consultation turned out to be positive. He/she considered that nurse-led consultations meant that the work became more stimulating, interesting and developing. The pediatric nurse had a significant task in that the children reached the right level of care both for the child's best interests and the activities. There was potential and willingness to develop nurse-led consultations to the emergency department for children. Conclusion: Nursing visits are positive for the pediatric nurse, because they contribute to the pediatric nurse developing in her profession, which in turn creates job satisfaction. Due to nurse visits, children who do not need a medical assessment can get help more quickly, which leads to shorter waiting times in the emergency department. In addition, the business benefits as nurse visits are more cost-effective.

Uppsatsen analyserar samråds- och dialogprocesserna vid planeringen av Väsjöområdet i Sollentuna kommun ur ett miljörättviseperspektiv, för att utreda hur dessa processer kan förbättras i att inkludera underrepresenterade grupper. Uppsatsen utreder även vilken syn på natur och miljö som förmedlas vid dessa processer och vad det får för påverkan på vem som ska involveras. Studien har utförts i form av en fallstudie där informanter från Sollentuna kommun intervjuats och dokument rörande exploateringen av Väsjöområdet studerats. Uppsatsens teoretiska ramverk består av miljörättvisa och medborgardeltagande. Den geografiska avgränsningen för uppsatsen utgår från de upprättade detaljplaneområdena gällande Väsjöområdet och tiden mellan juni 2006 och våren 2014. Resultatet visar att Sollentuna kommun vid en del av de samråd och dialoger som hållits arbetat aktivt för att öka den deltagande delen av befolkningen. Det visar även att bilden av natur och miljö fokuserar på lokal påverkan på den lokala miljön. Det gör det viktigt att involvera den lokala befolkningen. Dock saknas det en diskussion om Väsjöområdets framtida befolknings miljöpåverkan genom sin konsumtion.

Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network-Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge.

No description available.

In 1982, a new model of psycho-educational assessment, called the Initial Assessment and Consultation Approach (IAC), was introduced into the Education Clinic of the Division of Specialised Education at the University of the Witwatersrand (WITS). It has continued to be used in the new Emthonjeni Centre at WITS University. The IAC assessment model was developed in response to criticisms and limitations of existing assessment practices. It represents an approach that is client oriented, in that it encourages consultants and clients to arrive together at their own decisions. Key to the model is a joint problem-solving approach, where the concept of the client’s control, consent and commitment are imperative. The aim of this study was to explore student consultants’ perceptions of the IAC model of assessment. More specifically, the study explored the perceptions of the effectiveness of the IAC as a tool for psycho-educational assessment; the student consultants’ opinion regarding the model and lastly past students’ use of the IAC approach at internship sites or places of work. The results of the study were qualitatively examined through the use of thematic content analysis, which provided rich description participants’ opinions. The sample consisted of forty respondents. Information letters were distributed to all participants and data was gathered through the use of an online questionnaire. The questionnaire was structured specifically to elicit the participants’ perceptions of the IAC model of psycho-educational assessment. The results indicate that the IAC is perceived as an effective approach to psycho-educational assessment, by student consultants at WITS University, and many of the principles of the approach are continued to be adopted by past students at their internship sites or places of work.