[The quality of interdisciplinary communication]. / La qualità della comunicazione interdisciplinare.

Because of a continued increase of complex patients and the development of many areas of sub-specialities in medicine, the use and quality of interdisciplinary communication has been found to be lacking, especially between hospital and primary care physicians, causing a significant gap in the documentation, coverage and care of individual patients. The study focuses on state of the art interdisciplinary communication, with consideration given to current used tools and priorities. An ad hoc questionnaire surveyed 118 physicians about their profession, the types of patients, the frequency of complex cases, the tools used to communicate with each patient and how the physicians rated these tools. The rate of patients needing interdisciplinary communication is 17% of the entire patient sample, all of this percentage having complex health care needs (terminally ill, disabled, often without a personal support network). Physicians frequently used paper documents, despite their lack of quality, as well as the telephone to communicate with other colleagues. Computer devices were scarcely used. Many Doctors (71%) value the actual interdisciplinary communication of low quality, despite the fact that it is considered to have a significant influence on the quality of health care. New tools and methods are needed. For example, dedicated standards of multidisciplinary and multi-professional Continuing Medical Education (CME), as well as the use of computer tools allowing for shared clinical records.

Indications to upper gastrointestinal endoscopy in children with dyspepsia.

OBJECTIVES: The objective of the study was to ascertain the appropriateness of indications for upper gastrointestinal (UGI) endoscopy in children with dyspepsia. METHODS: We used the RAND/University of California at Los Angeles method to investigate the appropriateness of the opinions of a panel of experts. The panel judged 2304 theoretical patient scenarios defined by a combination of demographic and clinical variables. Descriptive and multivariate logistic regression analyses were performed. RESULTS: The panel rated UGI endoscopy as appropriate in 27.2% of cases, inappropriate in 14.3%, and dubious in 58.5%. Disagreement emerged for 21% of cases. UGI endoscopy was considered increasingly appropriate in cases with a positive family history of peptic ulcer and/or Helicobacter pylori infection (odds ratio [OR] 8.518, P < 0.0001), when dyspepsia interfered with activities of daily living ("sleep" OR 7.540, P < 0.0001; "normal activities" OR 5.725, P < 0.0001), and when patients were older than 10 years ("