Consultation Practice Research Articles

"The other side of the table…': Early career gynaecological oncologists' transition from trainee to trainer.

The transition to consultant practice represents an important transition from the role of trainee to trainer. We used the theoretical framework of Threshold Concepts to better understand this transition by analysing data from a broader qualitative study examining the experience of early career Certified Gynaecological Oncologists (CGOs) in Australia and New Zealand. Semi-structured interviews were conducted with CGOs of <5 years consultant experience. Transcripts were analysed using reflexive thematic analysis, sensitised by the theoretical framework of Threshold Concepts. Seven early career CGOs were interviewed. Analysis resulted in the construction of five main themes related to the trainer role, each demonstrating characteristics of Threshold Concepts: 'Part of becoming and being a consultant'; 'Managing complex work environments and training responsibilities'; 'Optimising near peer relationships'; 'Recency informing evolution of training'; and "'Being responsible and letting go…' - the next transition." The themes offer insights into the areas of the transition to trainer that are troublesome, the impact of negotiating these challenges on professional identity formation, and the strategies used by CGOs to negotiate them. Using the lens of Threshold Concepts, these experiences can be normalised, and supported through efforts to facilitate the development of skills in reflection, feedback, coaching and mentorship.

INTERVENÇÃO EDUCATIVA COM ENFERMEIROS SOBRE CONSULTA DE PUERICULTURA: UM ESTUDO DE MÉTODO MISTO

ABSTRACT Objective: to determine the effect and influence of an educational intervention on childcare consultation on nurses’ knowledge and practice. Method: a mixed research method was adopted, with a sequential explanatory design, characterized by a stage with a quantitative approach, developed in a quasi-experimental study, with 30 nurses, followed by a qualitative one, carried out by in-depth interview, with 11 nurses working in the Family Health Units of João Pessoa, Paraíba, Brazil. In quantitative analysis, descriptive statistics and proportion test were used, and in qualitative analysis, thematic analysis was used. Results: the effect of the educational intervention was statistically significant in the consultation dimensions: consultation frequency; child nutrition; physical examination; growth assessment; development assessment; and health education. In the qualitative stage, the influence of the intervention in expanding knowledge and changing some nurses’ practices in the aforementioned dimensions was understood, with agreement between the data found. Conclusion: the positive effect of the educational intervention on nurses’ knowledge and practice in childcare consultations was evident, enabling them to reflect on the content covered and promote changes in their daily lives.

Engineering and consulting services for project management in construction

Engineering is described as an engineering and consulting activity related to the solution of various engineering tasks during the development and creation, as well as the improvement of products, systems or processes. Within the specific investment and construction project, practical engineering is professional services of a research, design, production and technological nature. The objective of this research is to study the issues of engineering and consulting in construction, the application of model laws on engineering and engineering activities in construction, questions about the need for engineering and consulting services for project management in construction. The following tasks were solved in the research itself: the need for the introduction of engineering and consulting services for project management in construction was identified and justified; checkpoints were identified of processes at the stage of completion of the construction digitalization project (by project participants) required for the provision of engineering and consulting services; indicators were identified to assess the effectiveness of the construction digitalization project; criteria have been developed for assessing the effectiveness of the implementation of the construction digitalization project and an algorithm for the integrated functioning of the work of Russian consulting engineers in construction. Consulting engineers in construction may use the results and recommendations of this research in the practice of engineering and consulting.

Assessment of Community Pharmacists’ Response to Patients with PCOS with Adverse Drug Events in Qatar: Simulated Client Approach

The public considers community pharmacists the most accessible healthcare providers. Services provided by pharmacists such as dispensing, counseling, and monitoring of adverse drug reactions have positive effects on patient health. The aim of this study was to evaluate the Qatari community pharmacists' data gathering, labeling, dispensing, and counseling practices in response to patients with adverse drug events (ADE). This study is a simulated client (SC) observational descriptive study. Thirty community pharmacies were chosen at random and placed in one of the two groups with 15 interactions over the phone and 15 interactions in person. The case is about a patient with PCOS taking metformin who presented with bothersome diarrhea and sought assistance from a pharmacist. Simulated clients used the Data Collection Tool to gather data. Each simulated client completed forty interactions with community pharmacists. Ninety percent of pharmacists dispensed medication, mostly antibiotics (37.5%) and antidiarrheal (67.5%). A total of 7 pharmacists (17.5%) made referrals. The majority of pharmacists (87.5% and 82.5%, respectively) failed to obtain crucial patient information, such as the frequency and duration of diarrhea. The SC had to remind all the pharmacists that this is an ADE from metformin. More than one-third of pharmacists (43.75%) who dispensed medication did not label any of it. No significant difference was found between groups in data gathering and dispensing (P-value &gt;0.05). Current community pharmacy consultation, labeling, and counseling practices on ADEs are inconsistent with evidence-based practice and need to be improved. Such a study is scarce, and it is the first simulated client approach assessing the community pharmacy responses to ADE in the State of Qatar. This topic is important for minimizing the practice gap and to develop professional training programs that are desperately needed to advance the profession. Keywords: patient, pharmacies, adverse drug events, Poly Cystic Ovarian Syndrome, Qatar. https://doi.org/10.55463/issn.1674-2974.50.3.6

What Jokes Can Tell: A Top 5 of Ethical Transgressions in Consulting

Abstract In studies on consultant ethics clients are usually portrayed as their potential victims. However, in newspapers a different story can be found, when journalists report cased where clients and consultants have been partners in crime. To better map the common ethical transgressions in consulting, this study presents a top five based on interviews with consultants. In addition, the study illustrates these common transgressions with public jokes, found on the internet. The findings show how clients are not the only, and certainly not the most vulnerable stakeholder. Client interests are relatively well acknowledged in consultancies’ codes of conduct, and much more so than for example those of client staff, or junior consultants. This study contributes to consultant practice by emphasizing how consultant ethics should acknowledge more stakeholders than only clients. Likewise, it flags the issue of consultant independence, as it is consultants second most reported ethical challenge. The study contributes to the business ethics literature by demonstrating the illustrative value of business jokes in pointing at common ethical transgression, complementary to the less common and more severe cases journalists report about.

Application of Bibliotherapy in Gestalt Therapy: Fiction Books as a Stimulant of Personality Transformation

The theory of the Gestalt therapy which is based on the humanist attitude towards the personality is applied in the social work, education, etc. It is considered to serve as a foundation of interactive bibliotherapy. However, as the professional discourse of the experts of Gestalt has demonstrated, and as it has been proven by the lack of research of the application of bibliotherapy in Gestalt therapy, bibliotherapy is still being underused as an option in Gestalt treatment. Generally, even though the interdisciplinary field of bibliotherapy has been extensively explored, there is an incentive to share the scarce (in terms of quantity) models of the applied nature which would define how bibliotherapy could be systematically involved into various consultation practices with the objective to enhance their efficiency. The article presents one of the possible models of practical application of interactive bibliotherapy in the Gestalt practice which is based on the triple dialogue (in interaction with the therapist) and written reflection of brief fictional texts. The model is based on the grounds of aligning the paradigms of Gestalt therapy and bibliotherapy. Cases of 60 clients who were being applied bibliotherapy throughout the 7 years of operation of one practice were explored with the emphasis on the qualitative aspect. The results of the research proved the appropriateness of bibliotherapy as a secondary means to be applied in Gestalt therapy. It has been established that, under the appropriate field conditions, the properly selected fictional text as the mediator through the dialogue-based reflection with the therapist may help the client to perceive his/her unsatisfied needs and to alter in the desired direction within a shorter timeframe, i.e., it enables personality transformation. In such cases, works of fiction serve the function of the stimulants of the authentic intrapersonal communication (i.e., one’s inner experiences and their inner reflection) and the amplifying or reinforcing function of the stimulants of interpersonal communication. This corroborates the data of neurological research indicating that fiction intensively stimulates and even (trans)forms the intellectual and emotional self- and world perception of a reading individual. The presented model of the application of bibliotherapy may be beneficial not only for the practitioners of Gestalt, but also for librarians, social workers and education specialists as well as the practitioners of therapies of other types, while especially considering the lack of systematic descriptions of the application of bibliotherapy as an additional and enhancing means, which has been highlighted in the relevant literature.

Efficacy of Novafon Local Vibration Voice Therapy and Water Resistance Therapy: a meta-analysis

Treatment approaches for voice therapy are diverse and two treatment approaches in voice therapy with assistive devices will be evaluated and compared for efficacy. Evaluations of the treatment effects of different approaches are important for clinical consultation and evidence-based practice. To evaluate the efficacy of Novafon Local Vibration Voice Therapy (NLVVT) and Water Resistance Therapy (WRT) using Voice Handicap Index (VHI). Systematic literature search and meta-analysis with random effects model. The analysis of two databases (MEDLINE and CENTRAL) and a manual search from inception to September 19th 2021. Any clinical trial with case series in a pre-post design written in English or German that tested the efficacy of NLVVT or WRT using VHI (functional [F], physical [P], and emotional [E] aspects, and total score [T]) in adult voice patients with an organic or functional voice disorder was considered. Five eligible studies were identified (NLVVT n= 22; WRT n= 42). Both treatment approaches showed highly significant improvement in all aspects of the VHI (p-values< 0.01). In direct comparison, NLVVT achieved significantly higher improvements in VHI-T, VHI-F and VHI-E than WRT (p-values< 0.01). Comparable improvement was received in VHI-P (p= 0.28). NLVVT and WRT are effective treatments for voice disorders related to the subjective evaluation of a voice disorder. In direct comparison, NLVVT achieved higher improvements than WRT in most VHI aspects.

Ranging across Tavistock approaches to consulting with teams and organisations: a history, an inventory of key concepts, and links to key organisations

This article has been written to describe the history and range of Tavistock approaches to consulting with teams and organisations that have been key influences in my own experiences and consultancy practice over many decades. My hope is that it will provide some background for newcomers to our field as well as being a summary and literature review for others who are more experienced seeking some overview of our field.

“We’re all there to learn”: The experience of novice workplace-based assessors in anaesthesia training

Introduction: Workplace-based assessments (WBAs) are used in competency-based training programs to facilitate learning and inform decisions on trainees’ progression. Competency in assessing WBAs is generally assumed; how assessors develop these skills remains largely unknown. This study explored how novice assessors acquire WBA skills to generate insights to inform future faculty development. Methods: We conducted seven semi-structured interviews with provisional fellows, who are final-year trainees of the Australian and New Zealand College of Anaesthetists. Provisional fellows assess junior trainees as part of their preparation for consultant practice. We used constructivist grounded theory methods to analyse their experience of learning to perform WBAs. Results: Participants primarily learned WBA skills through experiential learning and self-reflection on their practice. They developed practical skills to accommodate WBA into clinical practice, including finding time to facilitate WBAs and selecting appropriate cases. Simultaneously, participants developed expertise in the critical aspects of the assessment, particularly learning to determine the standard required of trainees and improving their feedback skills. This learning engendered an increased appreciation of the purpose of WBA, helped participants develop their clinical expertise and prompted them to envision themselves in the consultant role. Participants felt underprepared for their assessor role and appreciated access to the “safety net” ongoing supervision provided. Conclusion: This study provides valuable insights into what is learned in becoming a WBA assessor and how it is learned. These insights could inform future faculty development initiatives to help improve graduating consultants’ development in this important area of consultant practice.

Efectos renales adversos por inhibidores del check-point (ICP) en pacientes con cáncer. Recomendaciones del grupo de Onconefrología de la Sociedad Española de Nefrología (SEN)

The most widely used approach in the immunotherapy treatment of cancer is the administration of monoclonal antibodies directed against regulatory molecules of immune control that inhibit the activation of T cells, the so-called check point inhibitors (ICI). ICI nephrotoxicity epidemiology and pathology; its diagnosis with or without kidney biopsy; the type and duration of treatment; the possibility of rechallenging after kidney damage; and its indication in patients with cancer and renal transplantation are certainly controversial. In the absence of definitive studies, this document is intended to specify some recommendations agreed by the group of onconephrology experts of the Spanish Society of Nephrology in those areas related to ICI nephrotoxicity, in order to help decision-making in daily clinical practice in onconephrology consultations.

NASP 2020 Professional Practice Standards: Applications and Opportunities for School-Based Consultation

ABSTRACT In this introduction to the special issue, we outline primary NASP Standards revisions which afford an opportunity for school psychologists (SP) to take on a more prominent role in school-based consultation grounded in social justice and equity. We point to advocacy in the NASP (2020) Standards for a lower 1:500 SP to student ratio, changes made to the description of particular NASP domains related to equity and schoolwide safety and practices (Domains 8 and 6) and more specific graduate education requirements for consultation training in practica as key changes that could facilitate a broader role of school psychologists in school-based consultation. The five articles in the special series are summarized with a focus on how the authors leverage the new NASP standards to advance training and the delivery of consultation practice to enhance equity and social justice in their respective settings.

OGBN O04 Upper Gastrointestinal Training in the UK &amp; Ireland – a Roux Group Study

Abstract Background Surgical training programmes in the United Kingdom and Ireland (UK&amp;I) are in a transition period evidenced by new surgical curricula. This study is the first to collate the opinions of UK&amp;I trainee and consultant surgeons regarding the current Upper Gastrointestinal (UGI) training model. Methods A questionnaire was developed and distributed via national UGI societies and the social media platform, Twitter. A total of 241 responses were received with all UK&amp;I regions represented. Results The median time to Certificate of Completion of Training (CCT) of 13 years was considered reasonable (50.2%), however the majority (67.2%) found training to be unfocused. The suggested targets for publications, presentations and audits were 3–5 (trainee vs consultant &amp;lt;3 vs 3–5, p&amp;lt;0.001), &amp;lt;3 (&amp;lt;3 vs 3–5, p=0.002) and 3–5 (&amp;lt;3 vs 3–5, p&amp;lt;0.001) respectively. The majority (61.9%) considered a higher academic degree advantageous but felt it should not be compulsory. Interestingly, most respondents (63.5%) had or planned to undertake one. Crucially, there were geographical discrepancies in access to training, particularly in bariatrics, robotic surgery, and endoscopy. Proficiency in diagnostic endoscopy was deemed essential for CCT and consultant practice (81.7% and 67.6% respectively). The current index UGI operative requirements were felt to be achievable (87.6%) but inadequate for day one consultant practice (74.7%), an opinion shared by both the trainee and consultant groups (p=0.662). Reassuringly, most respondents (76.3%) deemed there to be a role for on-the-job operative training following consultant appointment. Post-CCT fellowships were not considered necessary for consultant appointment, however the majority (73.6%) again recognised its advantage. Conclusions While variations were seen in the opinions of trainee and consultant surgeons, the current CCT requirements as outlined by the Joint Committee on Surgical Training are consistent with the overall perspective of the UGI community. Areas for improvement include flexibility in geographical working and provisions for endoscopy training, to ensure equal access.

Immersive virtual reality to promote leadership among health professions students

Leadership has been widely recognized as contributing to the delivery of high-quality healthcare. 1 Chamunyonga C. Edwards C. Caldwell P.J. Rutledge P. Burbery J. Advancing leadership in medical radiation sciences: incorporating systematic leadership education in pre-registration curricula. J Med Imaging Radiat Sci. 2021; 52: 499-504https://doi.org/10.1016/j.jmir.2021.09.014 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar , 2 Chamunyonga C. Edwards C. Caldwell P.J. Rutledge P. Burbery J. Leadership in the radiation therapy profession: the importance of understanding the potential benefits and theoretical perspectives. J Med Imaging Radiat Sci. 2020; 51: 535-539https://doi.org/10.1016/j.jmir.2020.09.008 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 3 Scammell J.M.E. Apostolo J.L.A. Bianchi M. et al. Learning to lead: a scoping review of undergraduate nurse education. J Nurs Manag. 2020; 28: 756-765https://doi.org/10.1111/jonm.12951 Crossref PubMed Scopus (14) Google Scholar Leadership is an important aspect of practice, essential across all health professions including but not limited to medicine, nursing, radiation sciences and allied health. 1 Chamunyonga C. Edwards C. Caldwell P.J. Rutledge P. Burbery J. Advancing leadership in medical radiation sciences: incorporating systematic leadership education in pre-registration curricula. J Med Imaging Radiat Sci. 2021; 52: 499-504https://doi.org/10.1016/j.jmir.2021.09.014 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ,4 Hudson D. Reflections on leadership in advanced and consultant radiographic practice within the UK. J Med Imaging Radiat Sci. 2021; 52: 164-171https://doi.org/10.1016/j.jmir.2021.02.003 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar While leadership is often associated with formal leadership roles and positions (e.g., directors and managers), leadership skills are equally important for point of care providers. 2 Chamunyonga C. Edwards C. Caldwell P.J. Rutledge P. Burbery J. Leadership in the radiation therapy profession: the importance of understanding the potential benefits and theoretical perspectives. J Med Imaging Radiat Sci. 2020; 51: 535-539https://doi.org/10.1016/j.jmir.2020.09.008 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ,5 Scully N.J. Leadership in nursing: the importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian. 2015; 22: 439-444https://doi.org/10.1016/j.colegn.2014.09.004 Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar ,6 Alcañiz M. Parra E. Chicchi Giglioli I.A. Virtual reality as an emerging methodology for leadership assessment and training. Front Psychol. 2018; 9: 1658https://doi.org/10.3389/fpsyg.2018.01658 Crossref Scopus (22) Google Scholar

Local Knowledge in American Archaeology: A Study in High Context Communication

Over the course of twenty five years, approximately 1990 to 2015, American archaeologists grew to accept the regular use of local knowledge, in the form of Native American and local community knowledge, in their development of archaeological knowledge and in cultural resource management. This change mostly pushed archaeologists to engage with groups of people that would have been ignored previously. This transformation is part of a larger process of Modernism becoming Post Modernism via the expanded use of high context communication, a concept from Communications Studies, throughout American culture. This paper briefly describes the use of local knowledge and summarizes structural changes in cultural resource management, especially consultation practices, that highlight a wider usage of high context communication.

Sexuality education and religion: From dialogue to conversation

AbstractThe relationship between sexuality education and religion is often framed antagonistically, especially when it comes to tensions between the teaching of sexuality education and the priorities of some religious communities. In this paper, we argue that this antagonism can be structured as much by the prevalent forms of engagement that display it (dialogue and debate), as it is by the antagonism between contrasting ethical systems. While we acknowledge the importance of debate and dialogue in the public sphere, we contend that appeals to these discursive forms in schools and classrooms can limit possibilities for rethinking engagements across sexuality education and religion. This is because of the tendency within certain manifestations of dialogue (for example, dialogical models connected to liberal political projects) to err on the side of predictability, rationality and abstraction. To address some of these limits, we draw on the recent turn to conversation in educational thinking. We think through the significance of conversation in offering a mode of engagement for students, teachers and school communities that is conditioned by the dispossession of the self and is attuned to the unpredictable, affective and contextual landscapes of shared encounters. We conclude with some thoughts on the practical implications of conversation for rethinking the role of the sexuality education teacher, practices of parental consultation and processes of policy enactment in schools.

Public Relations in Consultancy Practice: Empirical Insights from Ghana

This paper presents findings of a study on the nature of Public Relations (PR) in consultancy practice. The qualitative study specifically focused on case studies of three top PR management consultancies in Ghana. Drawing on the excellence theory as framework, the study involved in-depth interviews with a purposive sample of corporate communication managers from the three consultancies and review of corporate documents. The results suggest that the nature and dynamics of PR services provided in the three consultancies were similar although there were some notable variations in practice relative to patterns of work, account processes and fee structures. There were skilled professionals in the consultancies who offer a vast range of managerial PR services, predominantly on reputation management issues both offline and online, in addition to other technical functions. The study also established that the consultancies build strategic alliances and relationships with global holding companies to improve their competitive positioning and also create a wider network of diverse clientele. There is evidence that the consulting part of PR is currently booming. However, research on PR in consultancy practice has largely been neglected in the mainstream PR scholarship. The findings of the study, therefore, have implications for consulting firms recruiting PR professionals as well as consultants focusing on PR strategies and campaigns for their clients. The study also offers critical reflections on how PR strategies can effectively contribute to consultancy knowledge and practice beyond the Western context. The findings are original since no such research has previously been explored in Ghana.

“Unless you get to know us, you’re not going to know our passion”

In British Columbia, First Nation consultation is formally operationalized through land referrals, a system by which governments and industry proponents share information with First Nations about specific developments on their territories. Using the lenses of equal capacity, social learning, and Indigenous knowledge, this research examines land referrals processes on Nadleh Whut’en First Nation Territory to explore experiences with current consultation practices. Despite efforts to move towards equal decision-making authority over First Nation Territories, consultation remains a key aspect of Indigenous-Crown relations and it is critical that planners enhance their understanding of the duty to consult. Interviews with Nadleh Whut’en knowledge holders and land users and forestry key informants highlight deficiencies in the referrals process as a vehicle for engaging communities in decision making. Challenges include short timelines that manufacture false consent and a lack of cross-cultural dialogue centered on community values and needs. This research fills a gap by advancing understandings of the technical and procedural details of current consultation practice, including where it falls short in protecting Aboriginal rights and how such shortcomings impact people’s lives.

Localized lymphomatoid papulosis: Unilesional lymphomatoid papulosis, regional lymphomatoid papulosis, and persistent agmination of lymphomatoid papulosis.

Lymphomatoid papulosis (LYP), the most common primary cutaneous CD30-positive lymphoproliferative disorder, is heralded by multiple papular and nodular lesions at anatomically discontiguous cutaneous sites. The histologic patterns are protean. An uncommon form of LYP is one that is anatomically confined. Cases of unilesional LYP, regional LYP, and persistent agmination of LYP were encountered in the routine and consultative practices of Weill Cornell Medicine, Division of Dermatopathology. The clinical presentation, outcomes, light microscopic findings, and phenotypic profile are reviewed. There were 10 cases of LYP presenting as solitary plaques or nodules primarily occurring in older patients and without a relevant medical history in most. Most cases occurred at an acral site with many localized to the foot; the morphology was one of a necrotizing angiocentric type E pattern and borderline type C morphology. Two of the unilesional patients in our series went on to develop mycosis fungoides, one at the initial site of unilesional type A LYP, and the other at a discontiguous site. Excluding one case, the solitary lesions underwent complete regression; after the lesions regressed, some cases had no apparent recurrence. The second anatomically confined variant of LYP in our series was regional LYP exhibiting a type E morphology in two cases and a hybrid type A and granulomatous eccrinotropic morphology in one case. There was no subsequent development of lymphoma, nor was there any spread to additional anatomic sites. The final category was persistent agmination of LYP, whereby the agminated papules of LYP were superimposed on a plaque of cutaneous T-cell lymphoma represented by mycosis fungoides in two and follicular helper T-cell lymphoma in one. In conclusion, anatomically confined LYP defines an uncommon form of LYP, but it is an important one to recognize because the histology can be worrisome despite an indolent clinical course. The clinical presentation, the infrequent association with lymphoma/leukemia, and histology are similar to conventional LYP, although there appears to be a greater tendency for complete regression without recurrence, excluding cases of persistent agmination of LYP whereby the clinical course warrants categorization as a form of cutaneous T cell lymphoma (CTCL).

Instructions for COVID-19 self-tests

Abstract This paper summarises a cross-disciplinary project that explored ways of making instructions, funded as part of the UK COVID-19 rapid-response initiative. The project explored ways of making instructions for COVID-19 Lateral Flow Tests easy for lay people to use. Our method comprised rapid design decision making, where we used existing research, good practice in information design and consultation with diagnostic experts as part of the design process. Iterative review by a panel of users informed the development of prototype instructions: small studies investigated user preference for diagrams, and gathered feedback on the graphic articulation of the procedural steps involved in carrying out the test.

Nonsquamous Malignancies of Vagina and Vulva: 23-Year Experience at a Tertiary Center in the United Kingdom.

Under 10% of gynaecological cancers are diagnosed in the vulva and vagina, mostly squamous cell carcinomas. Melanoma, Paget disease, basal cell carcinomas, and other cancers can present with vulval/vaginal symptoms. The pathology information system of a tertiary referral center for vulvo-vaginal cancers was searched for cancers of the vulva and vagina from 1996 to 2019. Squamous carcinomas were excluded, and the remaining entities were catalogued. A total of 221 nonsquamous cancers were found, including 135 vaginal and 86 vulval cases. One hundred eight cases of metastatic carcinomas from the endometrium, cervix, ovary, bowel, bladder, kidney, and breast formed the largest category. Basal cell carcinomas constituted the second largest category. Others included melanomas, Paget disease, and adenoid cystic carcinomas. Primary adenocarcinomas included porocarcinoma, mammary type carcinoma, enteric type carcinoma, clear cell carcinoma, Bartholin gland adenocarcinoma and malignant transformation of hidradenoma papilliferum. The vulva and vagina can harbor a wide range of nonsquamous malignancies. The most challenging of these are adenocarcinomas which can be metastatic from other sites. The dominance of metastatic carcinomas in this series is likely to reflect consultation practice of specialist pathologists.