Doctor-patient communication with people with intellectual disability - a qualitative study

<p>Abstract</p> <p>Background</p> <p>People with intellectual disability (ID) expressed dissatisfaction with doctor-patient communication and mentioned certain preferences for this communication (our research). Since many people with ID in the Netherlands have recently moved from residential care facilities to supported accommodations in the community, medical care for them was transferred from ID physicians (IDPs) to general practitioners (GPs) in the vicinity of the new accommodation. We addressed the following research question: 'What are the similarities and differences between the communication preferences of people with ID and the professional criteria for doctor-patient communication by GPs?'</p> <p>Methods</p> <p>A focus group meeting and interviews were used to identify the preferences of 12 persons with ID for good communication with their GP; these were compared with communication criteria used to assess trainee GPs, as described in the MAAS-Global manual.</p> <p>Results</p> <p>Eight preferences for doctor-patient communication were formulated by the people with ID. Six of them matched the criteria used for GPs. Improvements are required as regards the time available for consultation, demonstrating physical examinations before applying them and triadic communication.</p> <p>Conclusions</p> <p>People with ID hold strong views on communication with their doctors during consultations. GPs, people with ID and their support workers can further fine-tune their communication skills.</p

Tectonic Evolution of the Nevado-Filábride Complex (Sierra de Los Filábres, Southeastern Spain): Insights From New Structural and Geochronological Data

The high-pressure metamorphic Nevado-Filábride Complex (NFC) in the Betics mountain range of southeastern Spain exhibits continental and ocean-derived tectonic units, which are key for understanding the geodynamic evolution of the Western Mediterranean. We address the current debate in the definition of tectonic units, the emplacement of (ultra)mafic rocks, and the timing of burial metamorphism by conducting a structural study combined with single grain fusion 40Ar/39Ar dating of white micas in structurally critical outcrops of the eastern Sierra de Los Filábres. One older 40Ar/39Ar age population (38?27 Ma) is found at distance from the main shear zones in the relics of an early foliation, while a younger 40Ar/39Ar population (22?12 Ma) is dominant in the vicinity of these shear zones, where the early foliation is obliterated. Both age groups are interpreted as the record of deformation or fluid-induced recrystallization during distinct fabric-forming events, while alternative scenarios are discussed. A key observation is the presence of an ophiolitic mélange, which?together with new and published geochronological data?allows for a new tectonic hypothesis. This considers Paleogene subduction beneath a Jurassic oceanic lithosphere, followed by the continued subduction of NFC and overlying ophiolites below the Alpujárride Complex. Exhumation during westward slab roll-back led to the formation of an extensional detachment system that obliquely cut nappe contacts. Although the timing constraints for high pressure-low temperature (HP-LT) metamorphism in the NFC remain inconclusive, the new tectonic hypothesis provides a solution that can account for both Paleogene and Miocene ages of HP-LT metamorphism