By Z. Ashton. Columbia College of Missouri.

However discount 200mg cordarone overnight delivery, a similar case could be made regarding inquiries about patient sexuality generic cordarone 200mg, substance abuse and other sensitive matters. These matters, formerly shunned by clinicians, are now discussed openly because of their potential effect on health. Indeed, lack of appropriate spiritual care may constitute a form of 138 negligence. Some authors suggest that clinicians ignore patient spirituality because they may not have the knowledge or skills to engage religiously diverse patients in meaningful 145 discussions about their spiritual needs without offending them. Autonomy, however, requires that clinicians respect the decisions of competent patients, which are often based on religious and spiritual beliefs. Furthermore, unrelated to medical decisions, patients often spontaneously raise spiritual issues and concerns with their clinicians. Taking a spiritual history and discussing and responding to spiritual concerns The medical interview involves more than information gathering. Indeed, interviews that are clinician controlled and narrowly biomedical are associated with reduced patient and clinician satisfaction, whereas interviews that are open-ended and patient controlled and 148 incorporate psychosocial factors are associated with greater satisfaction. Hence, 5,138 inquiring about spirituality may strengthen the clinician-patient relationship. Discerning the spiritual needs of patients can be straightforward by taking a spiritual history. For terminally ill patients, the spiritual 149–151 history is regarded as a crucial component of palliative medicine. Religious involvement, spirituality and medicine 237 25,141,152 Several formats for taking a spiritual history have been suggested.

Patient explains the matter in his or her own words and general practitioner uses interviewing technique to lead the conversation in order to confirm or dispatch any presentiments of diagnosis that well forth in mind buy cordarone 200 mg on-line. Based on the anamnesis and verbal communication general practitioner can also decide to take laboratory tests in order to make the diagnosis more accurate cheap 200mg cordarone free shipping. The behavior behind the sending of a referral can be explained by several factors that may all have an effect to tip the scale in favor of referring (Coulter, Noone & Goldacre, 1989). At the hospital, after examining an incoming referral, the specialist decides its level of urgency, again in one out of the three categories. Within the given time period the patient will be invited to hospital for consulting. The other option would be to send the referral back to the general practitioner if the specialist decides the case does not warrant specialist care. During our study the specialists working with traditional paper documents estimated that one out of five cases could have been treated at a health center with the help of some consultation. However, they felt that inviting a patient in for consulting that takes Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Towards Knowledge Intensive Inter-Organizational Systems in Healthcare 277 normally 20 minutes was less troublesome and took less time than writing and mailing instructions back to the general practitioner. Further, there were no economic incentives to take this trouble, since the local governments paid hospitals by the number of patients that were actually called in. In sum, the traditional process had neither procedures nor incentives for optimal resource allocation.

In monkeys cheap cordarone 200mg otc, all the digits are biomechanically coupled to a considerable degree purchase cordarone 100 mg fast delivery, and have overlapping representation in M1. In humans, the thumb and index finger are somewhat independent of the other fingers and have a distinguishable gradient of representation. In both species, the hand is biomechan- ically coupled to the wrist and forearm, M1 representation of which overlaps that of the hand in a proximodistal gradient. Also in both species, movements of the hand are independent of the face, and the M1 representations of the hand and face also are separate. Why has evolution of the M1 representation not proceeded to a more discrete somatotopic representation of body parts or muscles, similar to the discrete represen- tation of the body in the primary somatosensory cortex? Because of biomechanical coupling and muscle structure, the vast majority of hand and finger movements, even the highly individuated movements used in fine motor tasks, require the simultaneous control of multiple muscles, some moving the intended digit or digits and others stabilizing the other digits and the wrist. A network of intermingled and overlapping representations may be able to accomplish such control more efficiently than a network of discrete, spatially segregated nodes. The factors that make the intermin- gled representation biologically more efficient are unclear, but may include a benefit of maintaining shorter interconnections with shorter conduction times. Neurons active during various finger movements, with outputs to various subsets of finger muscles, are intermingled with one another, such that the cortical territory representing any particular body part, muscle, or movement overlaps extensively with the territory representing any nearby body part. This system presumably has evolved to control individuated movements of a peripheral apparatus that includes incompletely sub- divided muscles and biomechanical coupling among nearby body parts. Such a biological system is conceptually more complex than a robotic hand with indepen- dent digits, each driven by its own servomotor through a separate software channel. Nevertheless, a robotic hand is clumsy compared to the amazingly dextrous and flexible performance achieved by a biological hand controlled by the motor cortex. ACKNOWLEDGMENTS The authors thank Jennifer Gardinier and Lee Anne Schery for technical assistance, and Marsha Hayles for editorial comments. This work was supported by R01- NS27686 and R01-NS36341 from the National Institute of Neurologic Disorders and Stroke and BCS-0225611 from the National Science Foundation of the United States of America.