Comprehensive Consultation Research Articles

Genetic consultations in cases of unexplained fractures and haemorrhage: an evidence-based approach.

When infants and young children present with suspected physical abuse, it is critical to follow standard guidelines and rule out alternative causes of fracture and haemorrhage. A multidisciplinary team involved in the initial evaluation typically includes paediatrics, radiology, child protective services and/or law enforcement, and in complex cases, haematology, neurology, and genetics. A comprehensive genetics consultation includes review of the history of present illness, birth and past medical history, review of growth curves, family history, physical examination, radiological findings, and when indicated, biochemical and/ or genetic testing. A number of reports have mischaracterized several genetic disorders as child abuse mimics. There is a difference between a differential diagnosis, which includes every condition that can cause a fracture and/or subdural haemorrhage, and a mimic, so called because it can be difficult to differentiate from child abuse. In this review, we discuss the differential diagnosis for infantile fractures and subdural bleeds, highlight cardinal signs and symptoms of genetic disorders, and demonstrate that these genetic disorders can be readily differentiated and diagnosed using a stepwise approach. Genetic disorders rarely, if ever, are truly mimics of child physical abuse. In cases of suspected child physical abuse, multidisciplinary evaluations by paediatric specialists, keen clinical judgment, complete physical examinations, and judicious testing provides an evidence-based, time tested approach to excluding genetic disorders and diagnosing suspected child physical abuse.

Salpingectomy for the Risk Reduction of Ovarian Cancer: Is It Time for a Salpingectomy-alone Approach?

To summarize published evidence supporting current strategies for the prevention of epithelial ovarian cancer in women with a genetic, elevated risk for the development of this disease, as well as the emerging data on the novel salpingectomy with delayed oophorectomy (SDO) strategy. Furthermore, we will explore whether salpingectomy alone is a viable risk-reducing strategy for these women. We will also discuss current national guidelines for risk-reducing surgery based on patients' individual genetic predisposition. MEDLINE, PubMed, EMBASE, and the Cochrane Database, with a focus on randomized controlled trials and large prospective, observational studies. The key search terms for our review included Medical Subject Headings: "salpingectomy," "ovarian cancer," and "risk-reducing surgery." The fallopian tube is now well established as the site of origin for most ovarian cancers, particularly high-grade serous carcinomas. This finding has led to the development of new preventive surgical techniques, such as SDO, which may be associated with fewer side effects. However, until the results of ongoing trials are reported and the impact of SDO on ovarian cancer risk reduction is established, it should not be recommended outside of clinical trials, and bilateral salpingo-oophorectomy remains the treatment of choice for risk-reducing surgery, especially in women with a genetic, high risk for ovarian cancer. The decision to undergo risk-reducing surgery among women with an elevated risk for ovarian cancer should be made after comprehensive consultation and individually based on genetic predisposition, childbearing status, and personal preference.

The Role of Occupational Therapy with Children with Attention Deficit Hyperactivity Disorder (ADHD): A Canadian National Survey

ABSTRACT Children with Attention Deficit Hyperactivity Disorder (ADHD), a neurobehavioral disorder prevalent in childhood, demonstrate a persistent pattern of inattention and hyperactive and/or impulsive behavior that is more severe than their typically developing peers. Much of this challenging behavior is observed in the classroom. However, current literature on ADHD for school-aged children largely examines issues of clinical diagnosis and pharmacological management. Consequently, the associated challenges in functional limitations and participation restrictions that these children demonstrate have not been well examined. Fortunately, as members of the school-based team, occupational therapists are uniquely suited to address this important perspective. Therefore, the purpose of this study was to 1) identify the scope of occupational therapy (OT) practices in assessment, intervention and service delivery with children/youth with ADHD across Canada, 2) indicate potential research and practice gaps, and 3) discuss future implications with respect to OT intervention for children with ADHD. A bilingual national survey was created based on a comprehensive literature review and consultation with experts in pediatrics and knowledge translation. The survey link was sent to pediatric occupational therapists across Canada through mailing lists obtained from national and provincial organizations. A total of 172 surveys were completed (response rate = 10%). The majority of respondents reported that children with ADHD comprised 26–75% of their caseloads. More than 90% of respondents reported using OT interventions to address skills related to impairments (sensory processing), activity (fine motor function), and participation (school functioning) in their treatment of children with attentional disorders. OTs frequently reported using sensory-based principles to address the behavioral symptoms of children with ADHD. The most common form of service delivery was individualized sessions, followed by consultation. Potential gaps and implications at the research, practice and organizational levels are discussed to further support the role of OT with school-aged children with ADHD.

Optimizing telehealth pain care after COVID-19.

Optimizing telehealth pain care after COVID-19.

Vying with IKEA: HANSSEM’s Competitive Advantage at Marketing Frontier

HANSSEM is a furniture company that leads the market of residential space in Korea. The goal of this case study is to focus on how HANSSEM copes with IKEA, the world"s largest furniture retailer after entering the Korean market in December 2014. IKEA’s entry into Korea is possible to destroy the existing orders in the retail industry and reduce the profit of incumbent local players by realigning industry relationships. However, HANSSEM achieved rapid growth with the largest market share in the furniture market through its internal capabilities.<BR> The authors propose the main success factors in three ways: (1) residents-database including apartment floorplans in Korea, (2) high-quality human services provided by construction and A/S (After-sales Service), (3) channel diversification that provides comprehensive consultations (e.g., flagship stores, home shopping channels, stores in marts, and interior dealers).<BR> Especially, there have been various consumer needs in Korean market, such as creating their own stylish space economically. HANSSEM meets customer’s needs by reinforcing the space-package (complete-interior is provided to customer in a package rather than combining individual piece of furniture) and opening showrooms, which makes customers freely experience the products and receive detailed consultations on interior designs by alleviating customers’ difficulties in decorating their homes.<BR> Based on HANSSEM"s outstanding activities and new investments, we look forward to seeing that HANSSEM will achieve its ultimate goal of maintaining the position of number one furniture company by attaining customer satisfaction through higher quality in Korea.

Vying with IKEA: HANSSEM’s Competitive Advantage at Marketing Frontier

HANSSEM is a furniture company that leads the market of residential space in Korea. The goal of this case study is to focus on how HANSSEM copes with IKEA, the world"s largest furniture retailer after entering the Korean market in December 2014. IKEA’s entry into Korea is possible to destroy the existing orders in the retail industry and reduce the profit of incumbent local players by realigning industry relationships. However, HANSSEM achieved rapid growth with the largest market share in the furniture market through its internal capabilities. The authors propose the main success factors in three ways: (1) residents-database including apartment floorplans in Korea, (2) high-quality human services provided by construction and A/S (After-sales Service), (3) channel diversification that provides comprehensive consultations (e.g., flagship stores, home shopping channels, stores in marts, and interior dealers). Especially, there have been various consumer needs in Korean market, such as creating their own stylish space economically. HANSSEM meets customer’s needs by reinforcing the space-package (complete-interior is provided to customer in a package rather than combining individual piece of furniture) and opening showrooms, which makes customers freely experience the products and receive detailed consultations on interior designs by alleviating customers’ difficulties in decorating their homes. Based on HANSSEM"s outstanding activities and new investments, we look forward to seeing that HANSSEM will achieve its ultimate goal of maintaining the position of number one furniture company by attaining customer satisfaction through higher quality in Korea.

Development of a Virtual Consultation-Liaison Psychiatry Service: A Multifaceted Transformation

In response to the coronavirus disease 2019 (COVID-19) pandemic, our NYU Langone Health Tisch/Kimmel/Orthopedic Hospital Consultation-Liaison (CL) Psychiatry service underwent a multifaceted transformation to become a primarily Virtual CL Psychiatry service. We aimed to provide the hospital system with comprehensive psychiatric consultation for all patients, regardless of isolation status, while preserving personal protective equipment and avoiding unnecessary exposure to COVID-19 for our team members. In this article, we discuss harnessing technology for video consultations and transforming the multiple facets of an academic CL Psychiatry Service to become a comprehensive, functioning virtual consultation team during the COVID-19 pandemic. We review the history, best practices, legal, and regulatory considerations of using telepsychiatry for psychiatric consultations, challenges to implementation across multiple clinical sites, and expansion of the liaison role to include support of frontline colleagues. Finally, we provide the physician, trainee, and psychiatric nurse perspective as it relates to this transition. [ Psychiatr Ann . 2020;50(7):279–287.]

4차 산업혁명기술의 감정평가업무 활용과 영향*

This study analyzes utilization and influence of the Fourth Industrial Revolution(4IR) technology on appraisal works, based on the survey of appraisers. ANOVA and post hoc analysis such as Schaffer’s tests and Dunnett T3 were used for the analysis. The findings are as followed. First, it is big data and A.I. that have the biggest impact on overall competence. Second, segmentation of AI was the most beneficial effect of the 4IR; Third, data analysis and understanding and application of future technologies are particularly important in appraiser’s competency; Fourth, age and experience make a significant difference in autonomous driving, big data, FinTech, and drone (p&lt;.05). The study suggests implications for development of appraiser’s competency, based on the findings above. First, big data analysis and information and communication technology should be included in the appraiser qualification exam or training courses to strengthen appraisers’ competency. Second, a high level of thinking power beyond simple data analysis is required in the era of 4IR and they can be achieved by empowerment of expertise; Third, it is required that appraisers make efforts to diversify their services and strengthen their ability to provide comprehensive real estate consultation and market analysis.

Reparación integral: principios aplicables y modalidades de reparación

El objetivo de la presente investigación es analizar la reparación integral, los principios sobre los que se basa y los modelos de reparación integral. Los modelos de reparación pueden aplicarse en un mismo caso, por ello es necesario la evaluación del daño ocasionado para aplicar un tipo de reparación específica en la que puede concurrir la restitución, indemnización, rehabilitación, medidas de satisfacción y garantías de no repetición. La metodología que se utilizó es el método analítico sintético. El artículo consta de cuatro secciones. La primera sección desarrolla la introducción del trabajo de investigación. La segunda sección se analiza la reparación integral, su acceso y consulta a las víctimas de las reparaciones, los beneficiarios de las reparaciones, las reparaciones proporcionales adecuadas, causalidad; y, estándar y carga de la prueba. En la tercera sección se estudia los principios sobre los que se basan las reparaciones. En la cuarta sección se desarrolla los modelos de reparación integral, entre ellos la reparación individual que abarca la restitución, la indemnización monetaria y rehabilitación; y, en la reparación colectiva, se estudian las medidas de satisfacción y garantías de no repetición y se concluye que la reparación integral es un derecho de las víctimas reconocido en el derecho internacional por lo que se reconocen varios principios aplicables al momento de dictar una reparación, además existen dos modalidades para reparar integralmente a la víctima una que es la individual y otra que es la colectiva.

An Evaluation of the Effect of Pharmacist-Led Comprehensive Chemotherapy Consultation Services on Outpatient Appointment Adherence.

The North Carolina Cancer Hospital at the University of North Carolina Medical Center serves patients with a variety of malignant conditions and discharges more than 130 patients each month. Processes to improve transitions of care prompted implementation of a first-cycle, pharmacist-led chemotherapy consultation service on the inpatient oncology units. This process provides education to improve patient engagement and activation. High patient activation has been associated with better patient outcomes; poor patient activation has been associated with increased health care costs. To determine the effect of pharmacist-led comprehensive chemotherapy consultation services on adherence to outpatient follow-up appointments within 30 days of discharge. This was a single-center, retrospective chart review. This study consisted of 2 groups: adult patients who received comprehensive consultation services between April 2017 and September 2017 and a 2:1 historical group of adult control patients randomly selected from a list of patients who received their first cycle of chemotherapy during a hospital admission between April 2014 and April 2017. The primary endpoint was the effect of comprehensive consultation services on adherence to outpatient follow-up appointments within 1 month after discharge. Ninety-six patients were included in this study. The percentage of appointments attended was 98.0% for the intervention group and 92.3% for the control group (P = 0.0018). This study demonstrates that pharmacy consultation in the inpatient oncology setting is associated with improved adherence to outpatient appointments within 30 days of discharge. This represents the first published data on pharmacist interventions resulting in improved outpatient appointment adherence. Funding for this study was contributed by the Hematology/Oncology Pharmacy Association (HOPA). This publication was also supported by Grant Number UL1TR002489 from the National Center for Advancing Translational Sciences at the National Institutes of Health. Auten reports fees from PTCE and ASHP/ACCP, unrelated to this study. Clark reports consulting fees from Ellion Benson Research, unrelated to this study. The other authors do not have any conflicts of interest to report. This study was presented as a trainee poster on April 5, 2019, at the HOPA Ahead 15th Annual Conference in Fort Worth, TX.

Hematological Malignancies and Fertility.

In the last decades, survival rate of hematological malignancies has been significantly improved and sparing reproductive potential after treatment has become one of the goals in both male and female patients. A comprehensive consultation with reproductive specialists before the onset of any kind of cancer treatment procedure is an essential issue which would increase the likelihood of parenting in survivors. In this context, cryopreservation of oocyte, embryo or ovarian tissue in reproductive aged women and sperm or testicular tissue cryopreservation in adult male are feasible approaches that must be considered before gonadotoxic therapy. Notably, all options should be regarded as experimental during pre-pubertal period. Herein, we aim to review the available literature with regard to safety, efficacy of fertility preservation methods and the pregnancy outcomes in patients with hematological malignancies.

Cost-effectiveness of a patient-centred approach to managing multimorbidity in primary care: a pragmatic cluster randomised controlled trial

ObjectivePatients with multiple chronic health conditions are often managed in a disjointed fashion in primary care, with annual review clinic appointments offered separately for each condition. This study aimed to...

Consultation prevalence among children, adolescents and young adults with pain conditions: A description of age- and gender differences.

Pain is a common complaint presented in healthcare, but most epidemiological pain research has focused either on single pain conditions or on the adult population. The aim of this study was to investigate the 2017 consultation prevalence of a wide range of pain conditions in the general population of young people. We used the Skåne Healthcare Register, covering prospectively collected data on all healthcare delivered (primary and secondary care) to the population in the region of Skåne, southern Sweden (population 2017 n=1,344,689). For individuals aged 1-24 in 2017 (n=373,178), we calculated the consultation prevalence, stratified by sex and age, and the standardised morbidity ratio (SMR) to assess overall healthcare consultation. A total of 58,981 (15.8%) individuals consulted at least once for any of the predefined pain conditions. Of these, 13.5% (n=7,996) consulted four or more times for pain. Abdominal pain, joint pain/myalgia, headache and back/neck pain were the most common complaints. Overall, females had higher consultation prevalence than males: 17.6% versus 14.1% (p<.0001). SMR was 1.82 (95% CI=1.74-1.87) for females with pain and 1.51 (95% CI=1.42-1.56) for males with pain. Consultation prevalence increased with age, but this pattern varied between sex and pain condition. Among individuals under the age of 25, a significant proportion consult for pain already in early ages, and they also have high healthcare consultation rates for conditions other than pain. The even higher consultation rates among young females need additional attention, both in the clinic and in research. We present comprehensive 1-year healthcare consultation prevalence data covering all levels of care. A significant proportion of children, adolescents and young adults consult for different pain conditions at multiple occasions warranting greater clinical awareness.

Towards a deliberative approach in public health policy making

Abstract The time when public health policies could be based solely on expert opinion has gone. Public opinion has a real impact on the effectiveness of public health policy. However, for complex issues such as vaccination, screening, GMO’s, privacy and data governance, public opinion is divided. How to integrate divided public opinions into a well-structured health policy? In Belgium, as in many other countries, policy makers have started to turn to deliberative processes to guide policy making with citizen involvement, especially in ethically contentious areas. Deliberative processes aim to involve citizens in policy making in a setting where individual opinions and interests are weighed honestly and fairly, so that through well informed deliberation common ground can emerge. Participants are informed by a neutral information package, a variety of experts and facilitated discussions. In a very transparent way, these positions are molded into tailored policy inputs. In Belgium, such initiatives have recently been organized on biobanking, genomics, e-health, reimbursement policies and more. In France, the government is obliged by law to organize a comprehensive deliberative public consultation on bioethical issues every seven years. Especially in areas that require a large degree of trust, a deliberative approach ensures policies that can be supported by people with diverse views. They offer a viable alternative to traditional models of power and conflict that is more suitable to governance in 21st century democracies. They allow citizens to make a meaningful contribution to topics they may not have been familiar with beforehand, but that do touch on their private lives and interests. The most recent Belgian initiative resulted in nine concrete policy inputs for the implementation of genomics in health care, presented directly by the citizens to the Minister of Public Health. The French initiative is the basis for the current review of the law on bioethics in parliament. Key messages Public health issues touch the interests of all citizens: citizen deliberation should be regarded as an important input for public health policies. A deliberative approach enhances public trust, especially in areas of social or ethical contention.

Review and Application of the Mini-Clinical Evaluation Exercise (Mini-CEX) in Advanced Orthodontic Education: A Pilot Study.

The aims of this study were to review the evidence on the Mini-Clinical Evaluation Exercise (Mini-CEX) for work- based assessment and to assess, in a pilot study, the utility of the Mini-CEX in an advanced orthodontic education program. Three evaluators and six first-year orthodontic residents at one U.S. dental school were recruited for the study between July and December 2017. The evaluators used a modified Mini-CEX instrument with a nine-point scale (1=unsatisfactory to 9=superior) to observe 24 resident-patient encounters (four encounters per resident) that involved orthodontic screening and comprehensive consultation procedures. Seven domains were assessed: interviewing skills, clinical examination, professionalism, clinical judgment, counseling, organization, and overall competence. Evaluators gave individualized feedback immediately after each encounter and recorded the duration of encounter and feedback in minutes. Evaluators and residents also reported their satisfaction with the experience. The mean scores for the screening and consultation encounters were 7.21±1.39 and 7.96±0.97, respectively. Overall, the highest score of all the domains was in organization (8.00±1.14) and the lowest was in clinical judgment (7.11±0.96). Clinical performance improved over four encounters (7.80±0.92, 8.72±1.29, 8.98±1.13, and 8.52±1.45, respectively); however, the difference was not statistically significant. The mean duration of encounters was 15.05±2.39 minutes and of feedback was 8.25±4.64 minutes. Encounter duration was significantly longer in difficult cases than in moderate or simple cases (ANOVA, post-hoc p=0.004). The mean satisfaction rates of residents and evaluators were high (90% and 84%, respectively). Although there is no gold standard to assess clinical competence in dentistry, this study found that the Mini-CEX may be a potentially effective method of work-based assessment in advanced orthodontic education.

Beyond tokenism: meaningful youth engagement in planetary health

Beyond tokenism: meaningful youth engagement in planetary health

Comprehensive consultation model for explosion risk in mine atmosphere-CCMER

Mine gas explosion is one of the most feared hazards in the coal industry worldwide. More often one gas explosion related accident can cause the death of multiple coal miners. Examination of recent mine explosion disasters that have occurred in the worldwide reveals that most explosions originated from or around the sealed areas. Therefore, a good understanding of the atmospheric status in a sealed coal mine area is crucial in preventing and reducing accidents associated with mine combustible gases and also for planning and implementing a mine rescue strategy. In this paper, a PC based computer gas explosion consultation software model developed by the authors is introduced. This model is called CCMER (Comprehensive Consultation Model for Explosion Risk in Mine Atmosphere). The computer model is a comprehensive, reliable and user-friendly one. The nature of “comprehensive” means the model can be used to consult the explosibility of a gas sample taken from underground atmosphere, can assist engineers to know how explosion dangerous the situation is or what the risk degree is for a not-explosive atmosphere, and also can perform quantified analyses on the changing time span between not-explosive state and explosive state to guide the recuse works. All of those works are very important to mine operators understanding the mine atmosphere and then taking proper measures to control the potential risk. In addition to that, usages of developed computer program are also very easy. Users can operate the program without possessing an in-depth knowledge on computer and mathematical theory. Until today, CCMER has been successfully employed in numerous cases of designing and assessing various mine atmospheres during the past decades. The reliability of mathematical models used in CCMER has also been proven by such applications.

2019 AATS/ACC/ASE/SCAI/STS expert consensus systems of care document: A proposal to optimize care for patients with valvular heart disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.

This statement was commissioned as a Multisociety Expert Consensus Systems of Care Document by the American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI), and

Patient engagement in first cycle comprehensive chemotherapy consultation pharmacist services and impact on patient activation.

Healthcare systems and policy makers worldwide are demonstrating interest in shared decision making, which requires patient activation. Patient activation can be measured using a validated tool called the patient activation measure-10. First cycle comprehensive chemotherapy consultation services (3CS) is provided by an oncology pharmacy team member during a patient encounter at the beginning of the patient's treatment for cancer. This was a single center, prospective, non-randomized, observational clinical study in patients with cancer who required a new chemotherapy plan. A baseline patient activation measure-10 survey was administered and a pharmacy team member met with the patient to complete the first cycle 3CS encounter. Within two business days of that encounter, a second patient activation measure-10 survey was administered, and thus, patients served as their own control. Forty-nine patients who met the inclusion criteria were enrolled, of which 36 completed the study. Mean patient activation measure-10 scores measured at baseline and two business days after the 3CS encounter were significantly different (68.5 ± SD 14.7 vs. 75.0 ± SD 14.3, p = 0.001). This difference persisted when evaluated by gender (female: 70.0 ± SD 14.8 vs. 81.6 ± SD 10.5, p = 0.001; male: 66.1 ± SD 14.8 vs. 70.8 ± SD 14.7, p = 0.022). This study demonstrates that cancer patients had significantly increased patient activation scores after engagement in a 3CS encounter provided by an oncology pharmacy team. Further studies are needed to verify these data in a larger population, different healthcare settings, and to evaluate for patients who have solid tumor malignancies.

Key steps for a mental health and addictions performance measurement framework for Canada.

To inform the development of a pan-Canadian Mental Health and Addictions (MHA) performance measurement framework, we undertook a rapid review of the recent Performance Measurement (PM) literature and solicited input from 20 MHA policy and measurement experts. Six key steps for framework development were identified: recognizing and acknowledging key issues, developing shared language and understanding of key concepts, defining overall scope, defining framework dimension/domains, selecting indicators and using systematic engagement and consultation processes with stakeholders. Subject matter experts underscored the need for a comprehensive engagement process which would honour multiple stakeholder viewpoints and attend to key issues in the codesign of features of the PM framework. Findings from this analysis may be used to inform a comprehensive stakeholder consultation process for the development of a pan-Canadian PM framework for MHA.