Counseling Options Research Articles

Effects of Treatment Length and Chat-Based Counseling in a Web-Based Intervention for Cannabis Users: Randomized Factorial Trial.

BackgroundDigital interventions show promise in reducing problematic cannabis use. However, little is known about the effect of moderators in such interventions. The therapist-guided internet intervention Quit the Shit provides 50 days of chat-based (synchronous) and time-lagged (asynchronous) counseling.ObjectiveIn the study, we examined whether the effectiveness of Quit the Shit is reduced by shortening the program or by removing the chat-based counseling option.MethodsWe conducted a purely Web-based randomized experimental trial using a two-factorial design (factor 1: real-time-counseling via text-chat: yes vs no; factor 2: intervention duration: 50 days vs 28 days). Participants were recruited on the Quit the Shit website. Follow-ups were conducted 3, 6, and 12 months after randomization. Primary outcome was cannabis-use days during the past 30 days using a Timeline Followback procedure. Secondary outcomes were cannabis quantity, cannabis-use events, cannabis dependency (Severity of Dependence Scale), treatment satisfaction (Client Satisfaction Questionnaire), and working alliance (Working Alliance Inventory-short revised).ResultsIn total, 534 participants were included in the trial. Follow-up rates were 47.2% (252/534) after 3 months, 38.2% (204/534) after 6 months, and 25.3% (135/534) after 12 months. Provision of real-time counseling (factor 1) was not significantly associated with any cannabis-related outcome but with higher treatment satisfaction (P=.001, d=0.34) and stronger working alliance (P=.008, d=0.22). In factor 2, no significant differences were found in any outcome. The reduction of cannabis use among all study participants was strong (P<.001, d≥1.13).ConclusionsThe reduction of program length and the waiver of synchronous communication have no meaningful impact on the effectiveness of Quit the Shit. It therefore seems tenable to abbreviate the program and to offer a self-guided start into Quit the Shit. Due to its positive impact on treatment satisfaction and working alliance, chat-based counseling nevertheless should be provided in Quit the Shit.Trial RegistrationInternational Standard Randomized Controlled Trial Number ISRCTN99818059; http://www.isrctn.com/ISRCTN99818059 (Archived by WebCite at http://www.webcitation.org/6uVDeJjfD)

Mitochondrial Disease: Advances in clinical diagnosis, management, therapeutic development, and preventative strategies.

Primary mitochondrial disease encompasses an impressive range of inherited energy deficiency disorders having highly variable molecular etiologies as well as clinical onset, severity, progression, and response to therapies of multi-system manifestations. Significant progress has been made in primary mitochondrial disease diagnostic approaches, clinical management, therapeutic options, and preventative strategies that are tailored to major mitochondrial disease phenotypes and subclasses. The extensive phenotypic pleiotropy of individual mitochondrial diseases from an organ-based perspective is reviewed. Improved consensus on standards for mitochondrial disease patient care are being complemented by emerging therapies that target specific molecular subtypes of mitochondrial disease. Reproductive counseling options now include preimplantation genetic diagnosis at the time of in vitro fertilization for familial mutations in nuclear genes and some mtDNA disorders. Mitochondrial replacement technologies have promise for some mtDNA disorders, although practical and societal challenges remain to allow their further research analyses and clinical utilization. A dramatic increase has occurred in recent years in the recognition, understanding, treatment options, and preventative strategies for primary mitochondrial disease.

Knowledge, attitude, and behaviors of health professionals towards smoking cessation in primary healthcare settings.

This study aimed to assess the behaviors of multiple health professionals in primary healthcare settings in Jordan towards smoking cessation counseling and to determine the barriers to effective smoking cessation behaviors. A survey of 456 health professionals in primary healthcare settings was conducted. A self-administrated questionnaire was used to collect the data. About half of health professionals reported that they usually ask patients about smoking status and advise them to stop smoking (51.4% and 50.5%, respectively). Only 23.7% reported assessing the willingness of the patients to quit smoking and 17.9% reported discussing counseling options with smokers. Considerably fewer percentages of health professionals reported preparing their patients for withdrawal symptoms (6.0%), discussing pharmacotherapies (3.8%), and prescribing nicotine patches (6.4%). Key barriers to smoking cessation counseling, as reported by health professionals, included: insufficient resources and organizational support, limited coverage of cessation interventions, and lack of motivation to quit. Smoking cessation counseling was not routinely implemented by Jordanian health professionals. Barriers to effective delivery of smoking cessation counseling need to be integrated within relevant strategies aiming at enhancing the frequency and quality of health professionals' engagement in smoking cessation.

Health-related quality of life in transgender adolescents: Associations with body image and emotional and behavioral problems

ABSTRACTBackground: Transgender adolescents who apply for treatment often experience a marked increase in body-related distress when entering puberty, accompanied by internalizing problems and poor peer relations. Although adolescence is a time of considerable psychosocial and physical change, generally associated with a decline in health-related quality of life (HRQoL), research on HRQoL in transgender youth and possible predictors is sparse. This study thus aims to explore the predictive value of body image factors and emotional and behavioral problems for HRQoL.Methods: This cross-sectional one-group observational study was carried out at the Child and Adolescent psychiatric department (Gender Identity Service) in Hamburg, Germany. A sample of n = 126 (103 trans male and 23 trans female) adolescents, who were referred for counseling and/or treatment completed different standardized instruments before undergoing any sort of treatment. Firstly, five dimensions of HRQoL were explored in transgender adolescents and secondly, a linear regression model was applied to assess the impact of body image and emotional and behavioral problems on overall HRQoL.Results: HRQoL was generally impaired in transgender adolescents compared to norm scores, especially with regard to aspects of psychological and physical well-being. Linear regression analysis revealed that greater internalizing problems and less body satisfaction significantly predicted lower HRQoL outcomes.Conclusions: Impaired HRQoL may be explained by high degrees of internalizing problems and low body satisfaction. Thus, one important aim of mental health professionals working with youth should be to provide appropriate treatment and counseling options that may contribute to overall well-being in the long-term.

Group genetic counseling: An alternate service delivery model in a high risk prenatal screening population.

To address the growing demand for prenatal genetic services, group genetic counseling was explored as an alternative service delivery model for women with a positive prenatal screening result. Women were recruited from a prenatal genetic service and systematically allocated to a traditional individual appointment with a genetic counselor or a group genetic counseling session. Questionnaires were administered to assess patient psychological outcomes, knowledge, and satisfaction following individual and group genetic counseling for a positive prenatal screen. Genetic counselor time per type of patient was measured. Of 172 participants, 107 (62.2%) received group genetic counseling and 65 (37.8%) received individual genetic counseling. Both group and individual genetic counseling encounters significantly decreased patient anxiety, increased perceived personal control, decreased decisional conflict, and increased knowledge. Satisfaction was high following both methods. Anxiety was significantly decreased in women who received individual genetic counseling compared with group sessions (P<.001). Genetic counselors spent less time per group patient seen compared with individual patients. Group genetic counseling followed by the option of brief individual genetic counseling appears acceptable to women in a high-risk prenatal screening population. The findings support an alternative service delivery model for prenatal genetic services that could optimize the utilization of genetic counseling resources.

Doppler US in the Evaluation of Fetal Growth and Perinatal Health.

Fetal growth restriction is commonly defined as an estimated fetal weight (EFW) that is below the 10th percentile for gestational age. It is associated with an increased risk of intrauterine demise, neonatal morbidity, and neonatal death; therefore, antenatal detection and surveillance with the optimization of delivery timing are necessary to improve pregnancy outcomes. If the estimated due date has been verified and the EFW is below the 10th percentile for gestational age, the underlying cause should be investigated, since the clinical management, outcome, and counseling options are largely dependent on the cause of the growth restriction. Serial ultrasonography (US) for the evaluation of fetal growth and umbilical artery Doppler velocimetry are used to guide pregnancy management decisions. This article describes the accurate US detection and surveillance of fetal growth restriction, discusses the current obstetric and radiology literature regarding the use of Doppler velocimetry in the setting of fetal growth restriction, and describes the techniques for performing umbilical artery Doppler velocimetry. Although various Doppler techniques have been described in the setting of fetal growth restriction, only umbilical artery Doppler assessment is recommended to identify fetuses most at risk for poor outcome and to guide the timing of delivery. The use of other Doppler waveforms in this setting remains investigational. ©RSNA, 2017.

Patient-centered methadone treatment: a randomized clinical trial.

Methadone patients who discontinue treatment are at high risk of relapse, yet a substantial proportion discontinue treatment within the first year. We investigated whether a patient-centered approach to methadone treatment improved participant outcomes at 12 months following admission, compared with methadone treatment-as-usual. Two-arm open-label randomized trial. Two methadone treatment programs (MTPs) in Baltimore, MD, USA. Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7years [standard deviation (SD)=10.1] and 59% were males. Newly admitted MTP patients were assigned randomly to either patient-centered methadone treatment (PCM; n=149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or treatment-as-usual (TAU; n=151). The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in treatment. There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps>0.05) except Quality of Life Global Score (P=0.04; 95% CI=0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps>0.05). Patient-centered methadone treatment (with optional counseling and the counselor not serving as the treatment program disciplinarian) does not appear to be more effective than methadone treatment-as-usual.

Gynecological Practice Represents the Ideal Setting for Early Opportunistic Cardiovascular Prevention: A Cross-Sectional Survey in an Urban Female Population.

Cardiovascular diseases are the main cause of mortality for women worldwide, yet their impact is frequently underestimated. To raise awareness for preventative lifestyle measures other contacts with the healthcare system should be exploited. We analyzed access patterns to other healthcare specialists and population screening measures to identify options for opportunistic counseling on cardiovascular risk. We enrolled 1062 randomly selected German urban women aged 25-74 years in 2012-2013, divided into 5 age bands. Women were asked about sociodemographic characteristics, clinical and gynecological history, physician attendance patterns, screening behavior and primary sources of health and preventative information, and clinical examination attendance. Obstetrician/gynecologists (OBGYN) were the most frequently consulted physicians within the last 12 months (75.3%), more than general practitioners (GP; 74%). Attendance rates to OBGYNs were not affected by education or income, solely a body mass index (BMI) >30 associated with significantly reduced rates of attendance (OR = 0.4, CI 95% = 0.17-0.78, p = 0.009). Women with low to medium Framingham risk scores were more likely to attend an OBGYN than a GP if they attended only one specialist. Attendance of population screening measures is limited (<60% for all offers) and hence unsuitable for systematic cardiovascular counseling. OBGYN represent a very popular and equitable healthcare contact for women of all ages and this could be exploited for cardiovascular screening. Furthermore, the strikingly different sources of health information reported highlight a need for improved health communication and differentiation of messages.

"It Is What It Is".

Mark looked at me shyly through his oversized Elvis Costello–style glasses. Was he feeling embarrassed by his own reply, or just waiting for my reaction? He was sitting between his mom and dad, wearing a T-shirt with a huge Minion print. His braces showed when he smiled, something he does often in a disarming way. Over more than 20 years of working in the field of hereditary cancer as a clinical geneticist, I have witnessed many scientific developments and have met thousands of patients and families who were referred for genetic counseling. Routine becomes inevitable, but every now and then, there is someone or some family that sticks in mymind. Cycling home from the hospital at the end of that September day, I tried to figure out what it was in Mark’s story that had moved me. I first met this bright teenager, together with his parents, when he was referred by his general practitioner (GP) to our Family Cancer Clinic for genetic counseling and DNA testing. A genetic trait runs in the family that causes skin tumors, gynecologic problems, and kidney cancer. They know how the family history has evolved over the past 5 years and that Mark’s mother carries a fumarate hydrase mutation that causes hereditary leiomyomatosis and renal cell cancer (HLRCC). In the past 25 years, the notion that cancer can be hereditary has moved from an academic discourse among geneticists to mainstream modern medicine. The option of genetic counseling and testing is now part of many protocols in clinical oncology. What has made the difference and rewritten the script of patient-doctor interactions in hereditary cancer is the discovery of the BRCA1 and BRCA2 genes. Suddenly, a cancer that is all too common and, therefore, familiar to almost everyone could be hereditary, and it could affect you, your mother, or your cousin. The broader result is that people are now familiar with the concept that any cancer can be hereditary. Another consequence of the discovery of the BRCA genes is that breast surveillance and preventive surgery have become options available to proven mutation carriers. This means that a genetic predisposition is no longer synonymous with ill fate; it has become something carriers can act upon. Angelina Jolie’s revelations of her preventive surgery were the finishing touch that further increased public awareness. It is this actionability that led Mark’s mother to ask their GP for a referral for genetic testing. Mark’s mother had her uterus removed 3 years ago, and her kidneys are screened every 6 months. Mark is 13 years old and has always been in good health, but he has been suffering from headaches lately. His mother is worried, because Mark’s cousin died of renal cancer a few years ago at the age of 18, and this event still echoes through the family. I cannot help noticing thatMark’s 18-yearold sister is absent at this first consultation. I know she has not been tested. I try to divide my attention between Mark and his parents and seek to adapt my language to that used by teenagers. Does it help that I have kitchen table conversations with my own, slightly older, kids? Things are “chill” or “uncool,” jeans must be skinny, and social media is the world as they know it. His parents are worried, but what is Mark’s point of view? Has he given much thought about it? Can Angelina Jolie be a role model for a 13-year-old boy? “So Mark, can you tell me what you know of this disease that runs in your family?” I take off my reading glasses, smile like he does, and try not to make it sound like a test. Mark quickly looks at his mother, who nods encouragingly. Mark starts to tell me what they had been discussing at home: that his uncle is being treated for painful skin problems, that his mother had an operation, and that the death of his cousin had a large impact on the family. He knows that before he is 18 he will have to start with some kind of medical checkup. “That’s why we’re here,” he says. And yes, he thinks this genetic thing is a bit scary. His parents are listening while he speaks, and I think I see a mixture of pride and sorrow in their expressions. I compliment Mark on his description. “It must be a tough decision to make for the three of you,” I continue after a short silence. They all agree but in slightly different ways. Mark’s father

Optimizing psychosocial support during office-based buprenorphine treatment in primary care: Patients' experiences and preferences

ABSTRACTBackground: Buprenorphine maintenance treatment is effective and has been successfully integrated into human immunodeficiency virus (HIV) and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable. Methods: The authors conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes. Results: Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care. Conclusions: Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine-prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining nonjudgmental attitudes and shared decision-making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise.

Polarized Couples in Therapy: Recognizing Indifference as the Opposite of Love

How can a couple “fall in love” and then subsequently “stumble out of love”? For centuries, this question has perplexed partners, researchers, and therapists alike. Unlike falling out of love, which may be a long-term gradual decline in love, falling in love may occur without much deliberation like the famous “love at first sight.” During a developing love relationship, couples are more susceptible to ignoring a myriad of factors that will eventually influence their relationship. These ignored personal and general factors become increasingly conspicuous after the relationship is established. When facing relationship difficulties, the presence or absence of mutual love and intimacy steers the couple's relationship toward continuity or termination. Emotional indifference (which is the opposite of love) diminishes love and care; the terms marital disaffection and romantic disengagement are used synonymously to represent emotional indifference in couples. Marital disaffection is one of the central concerns of couples entering therapy. Nevertheless, spouses may enter therapy with divergent goals that may be polar opposites. Therefore, treatment of polarized or different agenda couples is challenging because disaffected spouses may be seeking counseling to break the bond at a safe venue, while their partners may still be obliviously hoping for the rebirth of their lost love. This article reviews marital disaffection/romantic disengagement and discusses counseling options for polarized couples.

KOUNCIL: Kidney-Oriented Understanding of Correcting Ciliopathies

Objective Nephronophthisis is an autosomal recessive renal ciliopathy that constitutes the leading monogenic cause of end-stage renal disease in children. The KOUNCIL consortium is a collaboration between the UMC Utrecht, the Radboud UMC Nijmegen and UC London aimed at elucidating the genetic etiology and pathophysiological mechanisms underlying nephronophthisis and identifying drugs that prevent or delay renal insufficiency. Our goal is to improve genome diagnostics, genetic counselling and therapeutic options for nephronophthisis patients. Methods We employ next-generation sequencing to identify novel disease genes in 100 nephronophthisis patients included within the AGORA biobank project. The functional effect of novel mutations is assessed using in vitro and in vivo models. Genotypic and phenotypic patient characteristics are registered in a nephronophthisis database, facilitating correlation analyses and identification of early phenotypic markers. Newly identified nephronophthisis-genes are incorporated into diagnostic next-generation sequencing panels of ciliary genes. We use a systems-biology approach to identify and functionally characterize nephronophthisis-associated protein modules. Finally, we use high-throughput repurposing screens in zebrafish embryos to identify FDA-approved drugs that halt renal failure. Results With this approach, we expect to uncover the causal mutation in 60-90% of nephronophthisis patients. KOUNCIL members were involved in the recent identification of three novel genes (IFT172, WDR34 and WDR60) for nephronophthisis-related disorders. Clinical guidelines and new diagnostic tools for nephronophthisis are developed and implemented in diagnostics. We expect to identify drugs that can lead to novel therapies for nephronophthisis. Conclusion The KOUNCIL study is designed to advance understanding of renal ciliopathies and improve clinical care for nephronophthisis patients.

Online suicide risk screening and intervention with college students: a pilot randomized controlled trial.

This pilot randomized controlled trial examined the effect of an online intervention for college students at risk for suicide, Electronic Bridge to Mental Health Services (eBridge), which included personalized feedback and optional online counseling delivered in accordance with motivational interviewing principles. Primary outcomes were readiness to seek information or talk with family and friends about mental health treatment, readiness to seek mental health treatment, and actual treatment linkage. Participants were 76 college students (45 women, 31 men; mean age = 22.9 years, SD = 5.0 years) at a large public university who screened positive for suicide risk, defined by at least 2 of the following: suicidal thoughts, history of suicide attempt, depression, and alcohol abuse. Racial/ethnic self-identifications were primarily Caucasian (n = 54) and Asian (n = 21). Students were randomized to eBridge or the control condition (personalized feedback only, offered in plain report format). Outcomes were measured at 2-month follow-up. Despite relatively modest engagement in online counseling (29% of students posted ≥1 message), students assigned to eBridge reported significantly higher readiness for help-seeking scores, especially readiness to talk to family, talk to friends, and see a mental health professional. Students assigned to eBridge also reported lower stigma levels and were more likely to link to mental health treatment. Findings suggest that offering students personalized feedback and the option of online counseling, using motivational interviewing principles, has a positive impact on students' readiness to consider and engage in mental health treatment. Further research is warranted to determine the robustness of this effect, the mechanism by which improved readiness and treatment linkage occurs, and the longer term impact on student mental health outcomes.

Effective Medical Education Resource Design and Integrative Learning: A Lesson in Autosomal Recessive Polycystic Kidney Disease

Autosomal Recessive Polycystic Kidney Disease (ARPKD) is the most common ciliopathy affecting children and has a diverse penetrance. Health care practitioners must be aware of the varying phenotypes and pathophysiology during embryonic development so that proper management and counseling options may be considered. With limited instructional contact hours during training, effective online learning resources are becoming increasingly important. The objective of this project was to create an interactive, online learning module to provide a comprehensive and integrated lesson on ARPKD and to evaluate its educational value at different years of training. The module was created using an actual ARPKD case integrated with a normal development tutorial and self‐assessment tools that provide instant feedback for reinforcement of the material. The module was given to first‐year medical students, graduate students and pathology residents in various years of training. The educational value of the module was evaluated by a user survey and quantitative comparison between pre‐ and post‐test scores, assessed before and after utilizing the module. A retention study was conducted thirty days after completion of the module to determine the long‐term educational value of this teaching modality. The results show that the interactive and clinically oriented module effectively promoted learning and retention, and was positively received by trainees in all stages. Stand‐alone, online learning modules that present clinical cases in a highly integrated manner show promise as an effective undergraduate and graduate medical education tool.

Next-generation sequencing-based genome diagnostics across clinical genetics centers: implementation choices and their effects.

Implementation of next-generation DNA sequencing (NGS) technology into routine diagnostic genome care requires strategic choices. Instead of theoretical discussions on the consequences of such choices, we compared NGS-based diagnostic practices in eight clinical genetic centers in the Netherlands, based on genetic testing of nine pre-selected patients with cardiomyopathy. We highlight critical implementation choices, including the specific contributions of laboratory and medical specialists, bioinformaticians and researchers to diagnostic genome care, and how these affect interpretation and reporting of variants. Reported pathogenic mutations were consistent for all but one patient. Of the two centers that were inconsistent in their diagnosis, one reported to have found ‘no causal variant', thereby underdiagnosing this patient. The other provided an alternative diagnosis, identifying another variant as causal than the other centers. Ethical and legal analysis showed that informed consent procedures in all centers were generally adequate for diagnostic NGS applications that target a limited set of genes, but not for exome- and genome-based diagnosis. We propose changes to further improve and align these procedures, taking into account the blurring boundary between diagnostics and research, and specific counseling options for exome- and genome-based diagnostics. We conclude that alternative diagnoses may infer a certain level of ‘greediness' to come to a positive diagnosis in interpreting sequencing results. Moreover, there is an increasing interdependence of clinic, diagnostics and research departments for comprehensive diagnostic genome care. Therefore, we invite clinical geneticists, physicians, researchers, bioinformatics experts and patients to reconsider their role and position in future diagnostic genome care.

Under CMS proposed rule, MTM coverage would expand greatly

CMS hopes to require Medicare Part D plans to expand the pool of patients eligible for Part D medication therapy management (MTM), according to the new proposed rule published Friday in the Federal Register. The proposed new criteria for Part D MTM eligibility would include patients having two or more chronic conditions, with at least one being a core chronic disease; taking any two or more covered Part D drugs; and having a minimum annual drug spend of $620. “CMS clearly indicated that they believe MTM is a quality service, that pharmacists’ services are very beneficial and cost effective, and that they fully intend for MTM utilization to expand significantly. It’s possible that something like 50% of Medicare beneficiaries will now be eligible for MTM, and it may well be more than that,” said Jillanne Schulte, JD, APhA Director of Regulatory Affairs. The agency’s loosening of the eligibility criteria for Part D MTM is a “great opportunity for pharmacists to show what they can do.” “One of the really great things about [the proposed rule] is it’s a floor. So if a plan wants to go above and beyond what’s in the rule, it can,” Schulte added. “It can extend MTM to any number of people, in theory.” APhA’s detailed analysis of CMS’s proposed rule on “Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs” is under way. The Association plans to comment by the deadline of March 7, 2014. “A lot of the rule is applicable more to Part D sponsors,” in terms of both fraud and abuse, and general organizational and contracting requirements, explained Schulte. But “a lot of these big changes are going to trickle down to pharmacists.” CMS also proposed changes related to the six protected drug categories or classes of clinical concern. When Part D started, CMS implemented a policy that all Part D plans must include on their formularies “all or substantially all” Part D drugs in six drug classes: antineoplastics, anticonvulsants, anti- retrovirals, antipsychotics, antidepres- sants, and immunosuppressants; the Affordable Care Act later made this policy the law, but allowed CMS to specify criteria for identifying protected classes through rulemaking, according to the agency’s January 6 fact sheet on the proposed rule. MORE ONLINE■An expanded version of this article is available at www.pharmacist.com/under-cms-proposed-rule-mtm-coverage-would-expand-greatly.■The CEO Blog perspective is available at www.pharmacist.com/CEOBlog/cms-proposes-rule-expanding-access-part-d-mtm. ■An expanded version of this article is available at www.pharmacist.com/under-cms-proposed-rule-mtm-coverage-would-expand-greatly.■The CEO Blog perspective is available at www.pharmacist.com/CEOBlog/cms-proposes-rule-expanding-access-part-d-mtm. Under two criteria proposed by CMS, the antineoplastic, anticonvulsant, and antiretroviral drug classes would remain protected classes of drugs, but as of 2015, Part D formularies would no longer be required to include all anti- depressants and immunosuppressants. “Antipsychotics will remain protected at least through 2015 while CMS evaluates additional considerations and the need for any other formulary exceptions,” according to the CMS fact sheet. CMS has “basically said that this is a cost issue,” said Schulte. The proposed rule also contains two big changes related to mail service that may result in more Part D beneficiaries walking into their local pharmacy. First, CMS would require mail-service pharmacies to fill prescriptions within 3 or 5 days and would not permit mail-service pharmacies to waive cost sharing for a Part D plan unless cost sharing is waived for all plan enrollees. “I don’t think the response from most Part D plans is going to be to waive more copayments. I think they’re going to cut the co- payment waivers off,” Schulte said. Second, CMS stated that new prescriptions and 30-day prescriptions should not be available through mail service. “If Part D plans comply, it’s going to be better for patients because when they do get a new prescription, they will have to see their pharmacist,” Schulte said. In addition to more patient counseling options, pharmacies may also see more foot traffic in stores.

Is It Time to Embrace Telephone Genetic Counseling in the Oncology Setting?

Is It Time to Embrace Telephone Genetic Counseling in the Oncology Setting?

Examining the Impact of a Pharmacists Postpartum Counseling Service; Evidence from a University Hospital

Purpose: To describe a pharmacist's counseling service pertaining to methods of contraception on the postpartum unit of a university hospital and to evaluate the number of postpartum patients who desire information on contraception with the demographics of age, public or private insurance, and whether the patient was English or Spanish-speaking.&#x0D; Methods: Retrospective cohort data analysis of postpartum women who received the option of counseling by a pharmacist or pharmacy intern at a university hospital over a year and 7 month period. There were 2,048 cases included for this study. The total number of patients who wanted information as well as pharmacist preparation time and counseling time were also noted.&#x0D; Results: Patients who were interested in a hormonal contraception method were 3 times more likely to desire counseling compared with patients who declined information (p&lt;0.05). Also, patients who wanted an implantable form of contraception were 8 times more likely to desire information compared with patients who declined counseling (p&lt;0.05). Patients in the age range of 18-25, 26-30, and 31-45 years were less likely (56%, 64%, &amp; 65%) to want counseling compared with the age range of 12-17 years (all p&lt;0.05). Lastly, patients who spoke Spanish were 3 times more likely to have been counseled compared with non-Spanish speaking patients. The number of postpartum patients counseled on different contraception methods was 1,546 versus 699 patients who declined counseling. Total pharmacist preparation time totaled 160.95 hours, while total patient counseling time totaled 204.55 hours.&#x0D; Conclusion: Overall, postpartum women who chose to be counseled by a pharmacist were considering either a hormonal or implantable method of contraception, were younger than the age of 17 and were Spanish speaking. The average amount of pharmacist preparation time spent was 4.3 minutes per patient and actual counseling time on average was 5.5 minutes per patient.&#x0D; &#x0D; Type: Original Research

Conflict Resolution Strategies Adopted From Parenting Coordination: Assisting High‐Conflict Coparenting Students

This article examines the challenges faced by nontraditional college students who are coparents as a result of divorce. The need for college counseling centers to have counseling options designed to assist this special population in successfully completing their academic pursuits is presented. Conflict resolution techniques based on the Parenting Coordination model are offered to help these students deal with the challenges of coparenting responsibilities.

Association Between PAX9 Single-Nucleotide Polymorphisms and Nonsyndromic Cleft Lip With or Without Cleft Palate

The purpose of this study was to investigate the contribution of PAX9 gene to the risk of nonsyndromic cleft lip with or without cleft palate (NS-CL/P). The samples consisted of 142 Korean NS-CL/P families (90 males and 52 females; 9 cleft lip, 26 cleft lip and alveolus, and 107 cleft lip and palate; 76 trios and 66 dyads). A total of 10 single-nucleotide polymorphisms (SNPs) were tested for association with Korean CL/P case-parent trios using transmission disequilibrium test (TDT) and conditional logistic regression models. The minor allele frequency, heterozygosity, and a χ test for Hardy-Weinberg equilibrium at each SNP were computed between parents. Pairwise linkage disequilibrium was computed as both D' and r2 for all SNPs. Both allelic and genotypic TDTs were performed for individual SNPs using family-based association test program. Sliding windows of haplotypes consisting of 2 to 8 SNPs were tested using haplotype-based association test program. Genotypic odd ratios were obtained from conditional logistic regression models using STATA software. The family-based TDT using individual SNPs and 2- to 8-SNP haplotypes of the gene indicated a significant association at rs17104928 (P = 0.014). The haplotype analysis revealed that the association was most significant for the haplotype consisting of 3 SNPs (rs2073247, rs17104928, and rs17176643; P = 0.007). G/A heterozygote at rs17104928 had a significantly increased association with NS-CL/P (genotypic odd ratio, 2.88; 95% confidence interval, 1.42-5.84; P = 0.0014, dominant model). The high-risk SNP and genotype may provide a better understanding of the etiologic role of PAX9 gene in NS-CL/P and potential options for genetic counseling.