Patients' requests for radiological imaging: A qualitative study on general practitioners' perspectives.

BACKGROUND: With the increasing availability of information, patients are becoming more informed about radiology procedures and requesting imaging studies. This qualitative study aims to explore factors that influence general practitioners' (GPs) decisions to fulfil patient requests for imaging studies during clinical consultation. METHODS: Semi-structured interviews were conducted with 10 GPs working across five private medical centres in Northwest Sydney. Conventional content analysis was used with emergent themes to identify GPs perspectives. RESULTS: Six themes stood out from the interviews with GPs fulfilling patient requests for imaging studies. They included four pertaining to patient factors: patient expectations, 'therapeutic scans', 'impressive labels' and entitled. Two further themes pertained to the GP perspective and included defensive medicine, and 'new patients'. Requests are fulfilled from anxious or health-obsessed patients, with GPs worrying about litigation if they refuse. However, GPs decline requests from patients with entitlement attitudes or during first visits. DISCUSSION: The findings suggest that GPs struggle to balance their responsibilities as gatekeepers of imaging with patients' expectations of request fulfilment. Clear guidelines on the appropriate use of diagnostic imaging and its limitations could help patients understand its proper use and ease anxiety. Additionally, education and training for GPs could help them manage patient expectations and provide appropriate care. PATIENT CONTRIBUTIONS: Patients, service users, caregivers, people with lived experiences or members of the public were not directly involved in the design, conduct, analysis or interpretation of the study. However, our study was conducted in primary care facilities where the GPs were interviewed about patients' requests for diagnostic imaging based on their own initiatives. GPs' perspectives in managing patient expectations and healthcare utilisation were explored within the Australian Medicare system, where medical imaging and image-guided procedures come at little to no cost to the individual. The study findings contribute to a better understanding of the challenges faced by GPs in dealing with patient consumerism and requests for diagnostic imaging, as well as factors influencing request fulfilment or denial. Insights gained from this study may inform future research about delivering patient-centred care within a similar context.

Using ultrasound visual feedback to remediate velar fronting in preschool children: A pilot study.

Anecdotally, velar fronting can be difficult to remediate in some children. This pilot study examined the use of ultrasound visual feedback in remediating velar fronting in typically developing children. A single-case, multiple-baseline across-subjects experimental design was used to examine acquisition, retention and generalisation of velar treatment targets. Two otherwise typically developing children (P1, aged 4;0; P3, aged 4;11) completed the study. The productions of /k/ and /É¡/ at syllable level were targeted during treatment. P1 improved her productions of /k/ and /É¡/ at syllable level during the treatment period and achieved correct production at word level during follow-up. P3 made no improvements in his productions of velar targets. This study suggests that ultrasound visual feedback may be an option for remediating velar fronting in some preschoolers. Further study is required.

Foetal monitoring: a woman-centred decision-making pathway.

PROBLEM: Many midwives continue to use continuous foetal monitoring on low risk women in labour, despite evidence based clinical guidelines to the contrary. Continuous foetal monitoring has been linked to increased rates of medical intervention during labour and birth with no improvement in long term neonatal outcomes. PARTICIPANTS: Midwives who used continuous foetal monitoring on low risk women in labour at two regional Queensland hospitals. METHODS: This Grounded Theory study explored midwives' decision-making processes related to the use of continuous electronic foetal monitoring on low risk labouring women. Primary data were gathered in semi-structured interviews with five purposively selected midwives and concurrently analysed using Grounded Theory techniques of theoretical sampling and constant comparison. FINDINGS: The midwives made the decision that led to continuous electronic foetal monitoring on low risk women at two key decision points during labour care; the first during the midwives' initial assessment of the woman and foetus, and the second when the midwives categorised the women as high or low risk. However, various factors impacted on these decisions including trust and staff workloads within a context of risk management and medical dominance. There was limited opportunity for women to be involved in the decision-making process about foetal monitoring and only partial information was provided prior to cardiotocography. CONCLUSIONS: Consistent with current clinical guidelines which recommend open, consultative discussion with the woman about foetal monitoring and a partnership approach towards decision-making following informed choice, a woman-centred foetal monitoring decision-making pathway is proposed. This pathway is applicable in midwifery education, research and clinical practice to promote both evidence based practice and woman-centred decision-making.