The aim of this study is to explore and summarize the development trajectory,current research landscape,and emerging trends of medication consultation in China,providing a valuable reference for future investigations ...The aim of this study is to explore and summarize the development trajectory,current research landscape,and emerging trends of medication consultation in China,providing a valuable reference for future investigations in this domain.Relevant articles on medication consultation were systematically collected,and bibliometric software such as CiteSpace 6.4R1 was employed to analyze author and institutional collaborations,keyword co-occurrence,clustering,and emerging trends.This approach helped elucidate key themes and hot topics in the field.A total of 1267 articles were included,with the peak number of publications recorded in 2011,followed by a steady decline in subsequent years.The most prolific author was Zhen Jiancun,contributing eight publications,while the First Affiliated Hospital of Sun Yat-sen University emerged as the leading institution with 11 publications.High-frequency identified keywords included medication consultation,rational drug use,pharmaceutical services,clinical pharmacists,and outpatient pharmacies.Cluster analysis revealed 12 significant themes,while emergent analysis highlighted that recent research hotspots centered on the Pareto chart,pregnancy,and traditional Chinese patent medicine.As a critical aspect of pharmaceutical services,the practice of medication consultation in China requires further advancement,with a particular need for enhanced collaboration among researchers and institutions.Moving forward,expanding the scope of medication consultation,improving the quality of related research,and fostering cross-regional collaboration among teams with diverse research focuses will be essential in deepening and broadening this field of study.展开更多
Despite government incentives,developers are reluctant to invest in green building initiatives due to their perceived extra costs-in particular additional consultant and construction implementation costs.This paper ex...Despite government incentives,developers are reluctant to invest in green building initiatives due to their perceived extra costs-in particular additional consultant and construction implementation costs.This paper examines the issues preventing the integration of Green Building Index(GBI)consultancy with residential building development in the Malaysian construction industry.Following a literature review of the challenges involving GBI consultancy at the early stage of green residential development,a semi-structured interview method was used to elicit opinion on perceived barriers to integrating the GBI process from 30 interviewees;mainly developers,GBI consultants,building consultants and regulators in the Malaysian construction industry with involvement in green building.The study found that a lack of communication between design team members and GBI consultants was a major barrier.This reduced the opportunity for a more collaborative effort to minimise costs and wastage during the design stages.Lack of insight into the impact of integrating the GBI consultancy into design process within the project time frames was evident.Effective coordination is necessary if the involvement of GBI consultants,particularly at early design stage,is to be successfully managed.It is recommended that work coordination among design team members and GBI consultants needs periodic review.展开更多
This paper explores whole-process engineering consulting,including its application models in public buildings and elderly-friendly projects,such as service integration and whole lifecycle management.It also addresses ...This paper explores whole-process engineering consulting,including its application models in public buildings and elderly-friendly projects,such as service integration and whole lifecycle management.It also addresses the construction of multi-dimensional collaborative theoretical models,public space streamline organization,and other aspects,emphasizing the importance of multi-dimensional collaboration.Additionally,it highlights the role of talent cultivation and digital transformation in enhancing project efficiency.展开更多
In a digital world moving at a breakneck speed,consultancy services have emerged as one of the prominent resources for seeking effective,sustainable and economically viable solutions to a given crisis.The present day ...In a digital world moving at a breakneck speed,consultancy services have emerged as one of the prominent resources for seeking effective,sustainable and economically viable solutions to a given crisis.The present day consultancy services are aided by the use of multiple tools and techniques.However,ensuring the security of these tools and techniques is an important concern for the consultants because even a slight malfunction of any tool could alter the results drastically.Consultants usually tackle these functions after establishing the clients’needs and developing the appropriate strategy.Nevertheless,most of the consultants tend to focus more on the intended outcomes only and often ignore the security-specific issues.Our research study is an initiative to recommend the use of a hybrid computational technique based on fuzzy Analytical Hierarchy Process(AHP)and fuzzy Technique for Order Preference by Similarity to Ideal Solutions(TOPSIS)for prioritizing the tools and techniques that are used in consultancy services on the basis of their security features and efficacy.The empirical analysis conducted in this context shows that after implementing the assessment process,the rank of the tools and techniques obtained is:A7>A1>A4>A2>A3>A5>A6>A7,and General Electric McKinsey(GE-McKinsey)Nine-box Matrix(A7)obtained the highest rank.Thus,the outcomes show that this order of selection of the tools and techniques will give the most effective and secure services.The awareness about using the best tools and techniques in consultancy services is as important as selecting the most secure tool for solving a given problem.In this league,the results obtained in this study would be a conclusive and a reliable reference for the consultants.展开更多
As Internet becomes largely used in the AEC (architecture, engineering andconstruction) industry, the main focus is in the area of information and project management. In thedynamic engineering consulting, less has bee...As Internet becomes largely used in the AEC (architecture, engineering andconstruction) industry, the main focus is in the area of information and project management. In thedynamic engineering consulting, less has been done so far. This research tries to find thepossibility and potential of the Internet application in design and consulting for the AEC industryby proposing a working model in specific area, steel construction. Several issues have beendiscussed: defining and formatting the typical procedure and character of the steel constructionconsulting, behavior approach based on activities among partners, and the model organization.展开更多
Knowledge transfer(KT)from the consultant to the client is an important area that needs to be repeatedly addressed and thoroughly understood.The aim of this research was to examine the assumption that client character...Knowledge transfer(KT)from the consultant to the client is an important area that needs to be repeatedly addressed and thoroughly understood.The aim of this research was to examine the assumption that client characteristics and consultant competencies play a defining role in the effective transfer of knowledge to the client party.The authors examined the critical aspects and competencies required of the consultant,and the characteristics and attitudes required of the client,which would contribute to a successful transfer of knowledge,through unstructured in-depth interviews and concise questionnaires.Eighty consulting assignments were studied from both the client side and the consultant side.A conceptual model is presented,factor analysis was used to validate the constructs,and partial least squares were used to test the model.The findings showed that the consultants’professionalism,skills,and behavior were significant contributors to KT to the client.Surprisingly,neither the consultant knowledge nor client characteristics had any significance to the KT to the client.展开更多
With the continuous development of urban and rural construction in China, the whole process engineering consulting work has been carried out in various regions of our country. However, in the process of implementation...With the continuous development of urban and rural construction in China, the whole process engineering consulting work has been carried out in various regions of our country. However, in the process of implementation, there are still many problems. Therefore, in order to promote the smooth development of the whole process consulting service, this paper studies its related theory and value embodiment, in order to provide reliable basis for relevant personnel to carry out their work.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
In consultative committee for space data systems(CCSDS)file delivery protocol(CFDP)recommendation of reliable transmission,there are no detail transmission procedure and delay calculation of prompted negative acknowle...In consultative committee for space data systems(CCSDS)file delivery protocol(CFDP)recommendation of reliable transmission,there are no detail transmission procedure and delay calculation of prompted negative acknowledge and asynchronous negative acknowledge models.CFDP is designed to provide data and storage management,story and forward,custody transfer and reliable end-to-end delivery over deep space characterized by huge latency,intermittent link,asymmetric bandwidth and big bit error rate(BER).Four reliable transmission models are analyzed and an expected file-delivery time is calculated with different trans-mission rates,numbers and sizes of packet data units,BERs and frequencies of external events,etc.By comparison of four CFDP models,the requirement of BER for typical missions in deep space is obtained and rules of choosing CFDP models under different uplink state informations are given,which provides references for protocol models selection,utilization and modification.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
Background: Cholecystectomy is considered a general surgical operation. However, general surgeons are not trained to manage severe complications such as bile duct injury(BDI) and should refer to hepatopancreatobiliary...Background: Cholecystectomy is considered a general surgical operation. However, general surgeons are not trained to manage severe complications such as bile duct injury(BDI) and should refer to hepatopancreatobiliary(HPB) surgeons when difficulty arises. This study aimed to investigate the outcomes of patients who had on-table HPB consults during cholecystectomy. Methods: This is an audit of 50 patients who required on-table HPB consult during cholecystectomy from 2011 to 2017. Consultations were classified as “proactive” and “reactive”, where consults were made before or after surgical incision, respectively. Patient demographics and perioperative details were collected. Results: The median age of the patients was 62.5 years [interquartile range(IQR) 50.8–71.3 years]. Eight(16%) patients had underlying HPB co-morbidity. Gallbladder wall was thickened in all patients(median 5 mm, IQR 4–7 mm), and common bile duct was of normal caliber in all patients(median 5 mm, IQR 4–6 mm). Median length of operation and length of stay were 165 min(IQR 124–209 min) and five days(IQR 3–7 days), respectively. Subtotal cholecystectomy was performed in 18(36%) patients. Forty-eight patients were initially managed by laparoscopic approach, 15(31%) required open conversion;majority(9/15, 60%) were initiated before on-table consult. Majority of referrals(98%) were reactive. Common reasons for referral included unclear anatomy or anatomical variations(30%), presence of dense adhesions and/or contracted gallbladder(18%) and impacted stones in Hartmann’s pouch(16%). Three(6%) patients were referred for BDI(2 Strasberg D and 1 Strasberg E1), and two(4%) were referred for torrential bleeding from arterial injury(1 cystic artery and 1 right hepatic artery). Any morbidity and 30-day readmission were 22% and 6%, respectively. There was no 90-day mortality. Conclusions: Calling for help in BDI is obligatory, but in other instances is a personal choice. Calling for help prior to open conversion is lacking and this awareness should be raised. Whether surgical outcomes could be improved by early HPB consult needs to be determined by larger multicenter reports.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
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
AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-na?ve patients.METHODS Colonoscopy-na?ve patients at two tertiary care hospitals complete...AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-na?ve patients.METHODS Colonoscopy-na?ve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation.Survey items included clinical pathway(direct or consult),procedure indication(cancer screening or symptom investigation),telephone and written contact from the physician endoscopist office,information sources,and pre-procedure anxiety.Participants reported pre-procedure anxiety using a 10 point scale anchored by "very relaxed"(1) and "very nervous"(10).At least three months following the procedure,patient medical records were reviewed to determine sedative dose,procedure indications and any adverse events.The primary comparison was between the direct and consult pathways.Given the very different implications,a secondary analysis considering the patient-reported indication for the procedure(symptoms or screening).Effects of pathway(direct vs consult) were compared both within and between the screening and symptom subgroups.RESULTS Of 409 patients who completed the survey,34% followed a direct pathway.Indications for colonoscopy were similar in each group.The majority of the participants were women(58%),married(61%),and internet users(81%).The most important information source was family physicians(Direct) and specialist physicians(Consult).Use of other information sources,including the internet(20% vs 18%) and Direct family and friends(64% vs 53%),was similar in the Direct and Consult groups,respectively.Only 31% of the 81% who were internet users accessed internet health information.Most sought fundamental information such as what a colonoscopy is or why it is done.Pre-procedure anxiety did not differ between care pathways.Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3,95%CI: 5.0-5.7(10 point Likert scale)] than those for screening colonoscopy(4.3,95%CI: 3.9-4.7).CONCLUSION Procedure indication(cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.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
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
To improve the efficiency and precision of our pharmacy consultation services,we adopted a"1+X"model based on the PDCA(Plan-Do-Check-Act)cycle.In the initial analysis,we identified factors contributing to su...To improve the efficiency and precision of our pharmacy consultation services,we adopted a"1+X"model based on the PDCA(Plan-Do-Check-Act)cycle.In the initial analysis,we identified factors contributing to suboptimal consultation efficiency.Our approach included a thorough examination of our pharmacy consultation system,encompassing personnel training,consultation promotion,and the refinement of the consultation process.A standardized pharmacy consultation model was devised and continually refined,with a primary focus on infectious diseases.Subsequently,the model expanded to include various medical specialties,fostering multi-disciplinary participation.Since the implementation of the"1+X"pharmacy consultation model,spanning from 2017 to 2022,consultation numbers exhibited a consistent annual growth exceeding 50%.In 2022 alone,5044 pharmaceutical consultations were conducted,encompassing 3007 standard consultations and 96 expanded consultations across diverse departments such as neurosurgery and neurology.The adoption rate of consultation recommendations reached 89.2%,while the effectiveness of consultation treatments stood at an impressive 76.4%.This success underscored the impact of the"1+X"pharmacy consultation model on enhancing consultation outcomes.Collectively,our model,rooted in the PDCA cycle,not only served as a practical blueprint for pharmacy consultation systems in medical institutions but also provided valuable insights and a robust framework for the professional development and training of clinical pharmacists.展开更多
Forest vegetation management has evolved as a recognized component of intensive forest management practice. It involves the management of competing vegetation necessary to obtain the high yields expected in modern for...Forest vegetation management has evolved as a recognized component of intensive forest management practice. It involves the management of competing vegetation necessary to obtain the high yields expected in modern forest plantations via control of interfering plants that influence regeneration outcome, impact timber stand development, and limit native plant and wildlife diversity. It includes cultural control, fire control, mechanical control, biological control, and chemical control. The public perception of forest vegetation management, especially chemical control, is sometimes negative due to health and environmental concerns. It is an important tool in the forest management alternatives available to consulting foresters managing family forest lands (the vast majority of private forest land in the United States). We report on a study that addresses the motivations of family forest owners that implement forest vegetation management practices and the motivation of those who chose not to implement after forester recommendations to do so. For those who do implement forest vegetation management, improvement of wildlife habitat and increased timber growth was the main motivation. For those who did not, cost was the main concern. Size of forest holding plays a major role in determining who will practice intensive forestry.展开更多
文摘The aim of this study is to explore and summarize the development trajectory,current research landscape,and emerging trends of medication consultation in China,providing a valuable reference for future investigations in this domain.Relevant articles on medication consultation were systematically collected,and bibliometric software such as CiteSpace 6.4R1 was employed to analyze author and institutional collaborations,keyword co-occurrence,clustering,and emerging trends.This approach helped elucidate key themes and hot topics in the field.A total of 1267 articles were included,with the peak number of publications recorded in 2011,followed by a steady decline in subsequent years.The most prolific author was Zhen Jiancun,contributing eight publications,while the First Affiliated Hospital of Sun Yat-sen University emerged as the leading institution with 11 publications.High-frequency identified keywords included medication consultation,rational drug use,pharmaceutical services,clinical pharmacists,and outpatient pharmacies.Cluster analysis revealed 12 significant themes,while emergent analysis highlighted that recent research hotspots centered on the Pareto chart,pregnancy,and traditional Chinese patent medicine.As a critical aspect of pharmaceutical services,the practice of medication consultation in China requires further advancement,with a particular need for enhanced collaboration among researchers and institutions.Moving forward,expanding the scope of medication consultation,improving the quality of related research,and fostering cross-regional collaboration among teams with diverse research focuses will be essential in deepening and broadening this field of study.
文摘Despite government incentives,developers are reluctant to invest in green building initiatives due to their perceived extra costs-in particular additional consultant and construction implementation costs.This paper examines the issues preventing the integration of Green Building Index(GBI)consultancy with residential building development in the Malaysian construction industry.Following a literature review of the challenges involving GBI consultancy at the early stage of green residential development,a semi-structured interview method was used to elicit opinion on perceived barriers to integrating the GBI process from 30 interviewees;mainly developers,GBI consultants,building consultants and regulators in the Malaysian construction industry with involvement in green building.The study found that a lack of communication between design team members and GBI consultants was a major barrier.This reduced the opportunity for a more collaborative effort to minimise costs and wastage during the design stages.Lack of insight into the impact of integrating the GBI consultancy into design process within the project time frames was evident.Effective coordination is necessary if the involvement of GBI consultants,particularly at early design stage,is to be successfully managed.It is recommended that work coordination among design team members and GBI consultants needs periodic review.
文摘This paper explores whole-process engineering consulting,including its application models in public buildings and elderly-friendly projects,such as service integration and whole lifecycle management.It also addresses the construction of multi-dimensional collaborative theoretical models,public space streamline organization,and other aspects,emphasizing the importance of multi-dimensional collaboration.Additionally,it highlights the role of talent cultivation and digital transformation in enhancing project efficiency.
基金Funding for this study was received from the Taif University Researchers Supporting Projects at Taif University,Kingdom of Saudi Arabia under Grant No.TURSP-2020/254.
文摘In a digital world moving at a breakneck speed,consultancy services have emerged as one of the prominent resources for seeking effective,sustainable and economically viable solutions to a given crisis.The present day consultancy services are aided by the use of multiple tools and techniques.However,ensuring the security of these tools and techniques is an important concern for the consultants because even a slight malfunction of any tool could alter the results drastically.Consultants usually tackle these functions after establishing the clients’needs and developing the appropriate strategy.Nevertheless,most of the consultants tend to focus more on the intended outcomes only and often ignore the security-specific issues.Our research study is an initiative to recommend the use of a hybrid computational technique based on fuzzy Analytical Hierarchy Process(AHP)and fuzzy Technique for Order Preference by Similarity to Ideal Solutions(TOPSIS)for prioritizing the tools and techniques that are used in consultancy services on the basis of their security features and efficacy.The empirical analysis conducted in this context shows that after implementing the assessment process,the rank of the tools and techniques obtained is:A7>A1>A4>A2>A3>A5>A6>A7,and General Electric McKinsey(GE-McKinsey)Nine-box Matrix(A7)obtained the highest rank.Thus,the outcomes show that this order of selection of the tools and techniques will give the most effective and secure services.The awareness about using the best tools and techniques in consultancy services is as important as selecting the most secure tool for solving a given problem.In this league,the results obtained in this study would be a conclusive and a reliable reference for the consultants.
文摘As Internet becomes largely used in the AEC (architecture, engineering andconstruction) industry, the main focus is in the area of information and project management. In thedynamic engineering consulting, less has been done so far. This research tries to find thepossibility and potential of the Internet application in design and consulting for the AEC industryby proposing a working model in specific area, steel construction. Several issues have beendiscussed: defining and formatting the typical procedure and character of the steel constructionconsulting, behavior approach based on activities among partners, and the model organization.
文摘Knowledge transfer(KT)from the consultant to the client is an important area that needs to be repeatedly addressed and thoroughly understood.The aim of this research was to examine the assumption that client characteristics and consultant competencies play a defining role in the effective transfer of knowledge to the client party.The authors examined the critical aspects and competencies required of the consultant,and the characteristics and attitudes required of the client,which would contribute to a successful transfer of knowledge,through unstructured in-depth interviews and concise questionnaires.Eighty consulting assignments were studied from both the client side and the consultant side.A conceptual model is presented,factor analysis was used to validate the constructs,and partial least squares were used to test the model.The findings showed that the consultants’professionalism,skills,and behavior were significant contributors to KT to the client.Surprisingly,neither the consultant knowledge nor client characteristics had any significance to the KT to the client.
文摘With the continuous development of urban and rural construction in China, the whole process engineering consulting work has been carried out in various regions of our country. However, in the process of implementation, there are still many problems. Therefore, in order to promote the smooth development of the whole process consulting service, this paper studies its related theory and value embodiment, in order to provide reliable basis for relevant personnel to carry out their work.
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.
基金supported by the National Natural Science Fandation of China (60672089,60772075)
文摘In consultative committee for space data systems(CCSDS)file delivery protocol(CFDP)recommendation of reliable transmission,there are no detail transmission procedure and delay calculation of prompted negative acknowledge and asynchronous negative acknowledge models.CFDP is designed to provide data and storage management,story and forward,custody transfer and reliable end-to-end delivery over deep space characterized by huge latency,intermittent link,asymmetric bandwidth and big bit error rate(BER).Four reliable transmission models are analyzed and an expected file-delivery time is calculated with different trans-mission rates,numbers and sizes of packet data units,BERs and frequencies of external events,etc.By comparison of four CFDP models,the requirement of BER for typical missions in deep space is obtained and rules of choosing CFDP models under different uplink state informations are given,which provides references for protocol models selection,utilization and modification.
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Background: Cholecystectomy is considered a general surgical operation. However, general surgeons are not trained to manage severe complications such as bile duct injury(BDI) and should refer to hepatopancreatobiliary(HPB) surgeons when difficulty arises. This study aimed to investigate the outcomes of patients who had on-table HPB consults during cholecystectomy. Methods: This is an audit of 50 patients who required on-table HPB consult during cholecystectomy from 2011 to 2017. Consultations were classified as “proactive” and “reactive”, where consults were made before or after surgical incision, respectively. Patient demographics and perioperative details were collected. Results: The median age of the patients was 62.5 years [interquartile range(IQR) 50.8–71.3 years]. Eight(16%) patients had underlying HPB co-morbidity. Gallbladder wall was thickened in all patients(median 5 mm, IQR 4–7 mm), and common bile duct was of normal caliber in all patients(median 5 mm, IQR 4–6 mm). Median length of operation and length of stay were 165 min(IQR 124–209 min) and five days(IQR 3–7 days), respectively. Subtotal cholecystectomy was performed in 18(36%) patients. Forty-eight patients were initially managed by laparoscopic approach, 15(31%) required open conversion;majority(9/15, 60%) were initiated before on-table consult. Majority of referrals(98%) were reactive. Common reasons for referral included unclear anatomy or anatomical variations(30%), presence of dense adhesions and/or contracted gallbladder(18%) and impacted stones in Hartmann’s pouch(16%). Three(6%) patients were referred for BDI(2 Strasberg D and 1 Strasberg E1), and two(4%) were referred for torrential bleeding from arterial injury(1 cystic artery and 1 right hepatic artery). Any morbidity and 30-day readmission were 22% and 6%, respectively. There was no 90-day mortality. Conclusions: Calling for help in BDI is obligatory, but in other instances is a personal choice. Calling for help prior to open conversion is lacking and this awareness should be raised. Whether surgical outcomes could be improved by early HPB consult needs to be determined by larger multicenter reports.
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.
基金Health Sciences Centre Medical Staff Council Resident Research Award
文摘AIM To investigate the effects of direct to colonoscopy pathways on information seeking behaviors and anxiety among colonoscopy-na?ve patients.METHODS Colonoscopy-na?ve patients at two tertiary care hospitals completed a survey immediately prior to their scheduled outpatient procedure and before receiving sedation.Survey items included clinical pathway(direct or consult),procedure indication(cancer screening or symptom investigation),telephone and written contact from the physician endoscopist office,information sources,and pre-procedure anxiety.Participants reported pre-procedure anxiety using a 10 point scale anchored by "very relaxed"(1) and "very nervous"(10).At least three months following the procedure,patient medical records were reviewed to determine sedative dose,procedure indications and any adverse events.The primary comparison was between the direct and consult pathways.Given the very different implications,a secondary analysis considering the patient-reported indication for the procedure(symptoms or screening).Effects of pathway(direct vs consult) were compared both within and between the screening and symptom subgroups.RESULTS Of 409 patients who completed the survey,34% followed a direct pathway.Indications for colonoscopy were similar in each group.The majority of the participants were women(58%),married(61%),and internet users(81%).The most important information source was family physicians(Direct) and specialist physicians(Consult).Use of other information sources,including the internet(20% vs 18%) and Direct family and friends(64% vs 53%),was similar in the Direct and Consult groups,respectively.Only 31% of the 81% who were internet users accessed internet health information.Most sought fundamental information such as what a colonoscopy is or why it is done.Pre-procedure anxiety did not differ between care pathways.Those undergoing colonoscopy for symptoms reported greater anxiety [mean 5.3,95%CI: 5.0-5.7(10 point Likert scale)] than those for screening colonoscopy(4.3,95%CI: 3.9-4.7).CONCLUSION Procedure indication(cancer screening or symptom investigation) was more closely associated with information seeking behaviors and pre-procedure anxiety than care pathway.
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.
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.
基金Jiangxi Provincial Hospital Pharmacy Special Research Fund Project(Grant No.2024-ZXYJ02)Jiangxi Provincial Department of Education Project(Grant No.200227)。
文摘To improve the efficiency and precision of our pharmacy consultation services,we adopted a"1+X"model based on the PDCA(Plan-Do-Check-Act)cycle.In the initial analysis,we identified factors contributing to suboptimal consultation efficiency.Our approach included a thorough examination of our pharmacy consultation system,encompassing personnel training,consultation promotion,and the refinement of the consultation process.A standardized pharmacy consultation model was devised and continually refined,with a primary focus on infectious diseases.Subsequently,the model expanded to include various medical specialties,fostering multi-disciplinary participation.Since the implementation of the"1+X"pharmacy consultation model,spanning from 2017 to 2022,consultation numbers exhibited a consistent annual growth exceeding 50%.In 2022 alone,5044 pharmaceutical consultations were conducted,encompassing 3007 standard consultations and 96 expanded consultations across diverse departments such as neurosurgery and neurology.The adoption rate of consultation recommendations reached 89.2%,while the effectiveness of consultation treatments stood at an impressive 76.4%.This success underscored the impact of the"1+X"pharmacy consultation model on enhancing consultation outcomes.Collectively,our model,rooted in the PDCA cycle,not only served as a practical blueprint for pharmacy consultation systems in medical institutions but also provided valuable insights and a robust framework for the professional development and training of clinical pharmacists.
文摘Forest vegetation management has evolved as a recognized component of intensive forest management practice. It involves the management of competing vegetation necessary to obtain the high yields expected in modern forest plantations via control of interfering plants that influence regeneration outcome, impact timber stand development, and limit native plant and wildlife diversity. It includes cultural control, fire control, mechanical control, biological control, and chemical control. The public perception of forest vegetation management, especially chemical control, is sometimes negative due to health and environmental concerns. It is an important tool in the forest management alternatives available to consulting foresters managing family forest lands (the vast majority of private forest land in the United States). We report on a study that addresses the motivations of family forest owners that implement forest vegetation management practices and the motivation of those who chose not to implement after forester recommendations to do so. For those who do implement forest vegetation management, improvement of wildlife habitat and increased timber growth was the main motivation. For those who did not, cost was the main concern. Size of forest holding plays a major role in determining who will practice intensive forestry.
