Communication in production animal medicine: modelling a complex interaction with the example of dairy herd health medicine

<p>Abstract</p> <p>Background</p> <p>The importance of communication skills in veterinary medicine is increasingly recognised. Appropriate communication skills towards the client are of utmost importance in both companion animal practice and production animal field and consultancy work. The need for building a relationship with the client, alongside developing a structure for the consultation is widely recognised and applies to both types of veterinary practice.</p> <p>Results</p> <p>Veterinary advisory practice in production animal medicine is, however, characterised by a more complex communication on different levels. While the person-orientated communication is a permanent process between veterinarian and client with a rather personal perspective and defines the roles of interaction, the problem-orientated communication deals with emerging difficulties; the objective is to solve an acute health problem. The solution - orientated communication is a form of communication in which both veterinarian and client address longstanding situations or problems with the objective to improve herd health and subsequently productivity performance. All three forms of communication overlap.</p> <p>Conclusions</p> <p>Based on this model, it appears useful for a veterinary practice to offer both a curative and an advisory service, but to keep these two separated when deemed appropriate. In veterinary education, the strategies and techniques necessary for solution orientated communication should be included in the teaching of communication skills.</p

Enfermedad cerebral, conectividad, plasticidad y terapia cognitiva. Una visión neurológica del trastorno mental

Resumen: Introducción: La relación entre mente y cerebro ha evolucionado desde el clásico dualismo hasta los conocimientos actuales que ponen de manifiesto que las funciones mentales son el resultado de la actividad cerebral. Este cambio de paradigma, junto con los recientes avances en diferentes técnicas de neuroimagen, ha dado lugar a una novedosa concepción del funcionamiento cerebral en términos de conectividad estructural y funcional. El objetivo del presente trabajo es describir la relación entre conectividad, lesión cerebral, plasticidad cerebral y recuperación funcional. Desarrollo: Si la función cerebral surge de la organización en red del cerebro como un todo, la disfunción cerebral se puede producir por una alteración en la conexión de estas redes. Así, a partir del modelo conectivista, los trastornos cognitivos y del comportamiento que aparecen tras una afección cerebral se describen como consecuencia de una alteración en la organización funcional de las redes cerebrales. Sin embargo, la pérdida de funciones puede ser recuperada gracias a la capacidad de los circuitos de ser dinámicos y versátiles. La plasticidad cerebral permite una reorganización funcional que llevará a una recuperación, espontánea o potenciada con terapia cognitiva, después de algún tipo de enfermedad cerebral. Conclusiones: El conocimiento de la conectividad y la plasticidad cerebrales proporciona una nueva perspectiva desde la que entender el funcionamiento cerebral en condiciones normales, los mecanismos del daño cerebral y los de la recuperación funcional, constituyendo las bases para el desarrollo de la terapia cognitiva. Abstract: Introduction: Our conception of the mind-brain relationship has evolved from the traditional idea of dualism to current evidence that mental functions result from brain activity. This paradigm shift, combined with recent advances in neuroimaging, has led to a novel definition of brain functioning in terms of structural and functional connectivity. The purpose of this literature review is to describe the relationship between connectivity, brain lesions, cerebral plasticity, and functional recovery. Development: Assuming that brain function results from the organisation of the entire brain in networks, brain dysfunction would be a consequence of altered brain network connectivity. According to this approach, cognitive and behavioural impairment following brain damage result from disrupted functional organisation of brain networks. However, the dynamic and versatile nature of these circuits makes recovering brain function possible. Cerebral plasticity allows for functional reorganisation leading to recovery, whether spontaneous or resulting from cognitive therapy, after brain disease. Conclusions: Current knowledge of brain connectivity and cerebral plasticity provides new insights into normal brain functioning, the mechanisms of brain damage, and functional recovery, which in turn serve as the foundations of cognitive therapy. Palabras clave: Plasticidad cerebral, Daño cerebral, Terapia cognitiva, Alteraciones del comportamiento, Trastornos mentales, Keywords: Brain plasticity, Brain damage, Cognitive therapy, Behaviour disorders, Mental disorder

Sociocultural study on the self-perception of stroke and an analysis of doctor-patient communication

Background: Stroke was historically attributed to magical and religious conceptions. We analyse the self-perception of stroke in stroke patients, the knowledge of vascular risk factors (VRF), and doctor-patient communication efficacy from an anthropological perspective. Material and methods: Prospective study of stroke patients by semi-structured, in-depth interviews. Those with modified Rankin Scale>3, aphasia or severe dysarthria were excluded. The quality of the information from health staff to the patients, as well as the evaluation of this information by the health staff themselves, were analysed. Results: The study included 100 patients (56 men), with a mean age of 61 (SD 16) years. Low educational level was present in 51%. Up to 83% did not know what was happening with the first stroke symptoms, and only 56% went to an emergency department initially. Only 19% could identify all their vascular risk factors (VRF), and up to 57% thought that the cause was due to a fortuitous factor. Poor knowledge of stroke was associated with low educational level (OR: 2.81; 95% CI, 1.14–6.90, P=.024). Up to 75% of the patients did not understand the information provided by their doctor, but 65% felt well informed. Furthermore, up to 69% of physicians thought that patients were well informed; the same percentage felt that low educational level made communication difficult. Conclusions: The knowledge of stroke and its VRF in stroke patients is low. They perceive it as something fortuitous associated to a strong emotional impact. Communication between doctors and stroke patients is relatively poor, although neither physicians nor patients detect this fact. This poor knowledge of stroke and VRF could have a negative influence on secondary prevention compliance. Resumen: Introducción: Históricamente el ictus se vinculó a concepciones mágico-religiosas. Analizamos la autopercepción del ictus en los pacientes, el conocimiento sobre factores de riesgo vascular (FRV) o desencadenantes, y la eficacia de la comunicación médico-paciente, desde un punto de vista antropológico. Material y métodos: Estudio prospectivo de pacientes con ictus, mediante entrevistas en profundidad y observación participante. Excluimos pacientes con una escala de Rankin modificada > 3, afasia o disartria grave. Analizamos la calidad de la información ofrecida por el personal sanitario y su propia valoración, mediante encuestas abiertas. Resultados: Se entrevistaron 100 pacientes (56 hombres), edad media 61 (DE 16). El 51% tenía un nivel educativo inferior o igual al básico. El 83% no reconocía que ocurría al sufrirlo y sólo el 56% acudió directamente a Urgencias. Un 19% identifica sus FRV y hasta el 57% piensa que lo desencadenó un factor fortuito. El desconocimiento de la enfermedad se asoció con un nivel educativo bajo (OR 2,81; IC 95%: 1,14–6,90; p = 0,024). Un 75% no entiende el discurso biomédico, pero un 65% afirma sentirse bien informado. Por otro lado, el 69% del personal sanitario facultativo piensa que los pacientes están bien informados; similar porcentaje considera que el “bajo nivel cultural” dificulta la comunicación. Conclusiones: El conocimiento de la enfermedad y sus FRV en los pacientes con ictus es escaso. Suelen percibirlo como algo fortuito asociado a un fuerte impacto emocional. La comunicación médico-paciente es ineficaz, ni profesionales ni pacientes detectan esta realidad. Esta falta de conocimiento de su enfermedad y sus FRV podría influir negativamente en una buena prevención secundaria. Keywords: Stroke, Perception, Risk factors, Doctor-patient communication, Palabras clave: Ictus, Percepción, Factores de riesgo, Comunicación médicopacient