Counseling Procedures Research Articles

“Notify Your Partners—It’s the Law”

HIV care providers in the United States must counsel clients about disclosure to sexual partners and report anyone who is suspected of noncompliance. This study compared provider attitudes and practices in relation to counseling clients about mandatory disclosure in North Carolina and Alabama, the 2 states with similar HIV epidemiology but different laws for HIV control. Personal interviews were conducted with 20 providers in each state (n = 40). The results were analyzed in a qualitative, cross-comparison method to identify patterns of convergence or difference. Providers in both states believed that clients often failed to notify sexual partners and were secretive if questioned about disclosure. Differences in counseling styles and procedures for each state were noteworthy. Compared to Alabama, North Carolina had harsher penalties for nondisclosure, stricter and more standardized procedures for counseling, and providers expressed greater support for HIV criminalization. Although most North Carolina providers viewed the stricter standards as beneficial for HIV care and control, Alabama providers were likely to view such standards as a barrier to patient care. These results indicated a direct relation between state HIV law, provider attitudes, and counseling procedures for mandatory disclosure.

Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer

BRCA1/2 mutation carriers with breast cancer are at high risk of contralateral disease. Such women often elect to have contralateral risk-reducing mastectomy (CRRM) to reduce the likelihood of recurrence. This study considers whether CRRM improves overall survival. 105 female BRCA1/2 mutation carriers with unilateral breast cancer who underwent CRRM were compared to controls (593 mutation carriers and 105 specifically matched) not undergoing CRRM and diagnosed between 1985 and 2010. Survival was assessed by proportional hazards models, and extended to a matched analysis using stratification by risk-reducing bilateral salpingo-oophorectomy (RRBSO), gene, grade and stage. Median time to CRRM was 1.1years after the primary diagnosis (range 0.0-13.3). Median follow-up was 9.7years in the CRRM group and 8.6 in the non-CRRM group. The 10-year overall survival was 89% in women electing for CRRM (n=105) compared to 71% in the non-CRRM group (n=593); p<0.001. The survival advantage remained after matching for oophorectomy, gene, grade and stage: HR 0.37 (0.17-0.80, p=0.008)-CRRM appeared to act independently of RRBSO. CRRM appears to confer a survival advantage. If this finding is confirmed in a larger series it should form part of the counselling procedure at diagnosis of the primary tumour. The indication for CRRM in women who have had RRBSO also requires further research.

Activities Raising Organizational Awareness for Intercultural Diversity

AbstractWhich activities raise organizational awareness for intercultural diversity? This was the main question of the German project Economy by Diversity. The first aim of this article is to answer this question. Examples and empirical findings of the project work will help illustrate the approach chosen by the project team to bring cultural diversity in small‐ and medium‐size enterprises (SMEs).The article also discusses the usefulness of the often‐criticized access–legitimacy paradigm based on the evaluation results. The project concentrates on a counseling procedure to transfer the topic of diversity into SMEs. It was evaluated using observation records and interviews with the executive board and employees. Early findings indicate that the organizational executives expect financial benefits from their concern with diversity. It is important for them to discover opportunities to link their concrete work to a topic such as diversity.Another focus of the article is that primary access to an organization to work with the topic of diversity succeeds by concentrating on one certain diversity dimension. By including external perspectives concerning organization and market, the enterprise could be pushed to reflect its primary organizational focus. In addition, there is an organizational need for exchange and networking with individuals who have an immigrant history.

The effects of the counseling on life style of menopausal women and

The effects of the counseling on life style of menopausal women and

Interventional Pain Management for Failed Back Surgery Syndrome

Patients who suffer from the condition known as failed back surgery syndrome (FBSS) present to the offices of physicians, surgeons, and pain specialists alike in overwhelming numbers. This condition has been defined as persistent back and/or leg pain despite having completed spinal surgery. As lumbar surgery continues to grow in prevalence, so will the number patients suffering from FBSS. It is important for physicians treating this population to expand their knowledge of FBSS etiologies and appropriate diagnostic imaging modalities, combined with confirmatory diagnostic injections, and proper technique for interventional pain procedures. In doing so, the physician may adequately be prepared to manage these complex cases in the future, ideally with the support of stronger evidence. Management begins with a systematic evaluation of common FBSS etiologies such as new-onset stenosis, recurrent herniated nucleus pulposus (HNP), epidural fibrosis, pseudarthrosis, and others. History and physical may be supplemented by imaging including X-ray, magnetic resonance imaging, or computed tomography myelography. Certain diagnoses may be confirmed with diagnostic procedures such as intra-articular injections, medial branch blocks, or transforaminal nerve root blocks. Once an etiology is determined, a multidisciplinary approach to treatment is most effective. This includes exercise or physical therapy, psychological counseling, medication, and interventional procedures. The most invasive treatment option, short of revision surgery, is spinal cord stimulation. This intervention has a number of studies demonstrating its efficacy and cost-effectiveness in this population. Finally, revision surgery may be used when indicated such as with progressive neurological impairment or with issues regarding previous surgical instrumentation.

A Focus on the Impact of Bariatric Surgery on Pregnancy Outcome: Effectiveness, Safety and Clinical Management

Due to the increase in obesity worldwide, nowadays about 1 in 5 women are obese when they conceive. Even if the International recommendations on weight gain during pregnancy recommend to treat obesity before a woman becomes pregnant, these suggestions often results fruitless due to the difficulty of losing weight, especially in cases of morbid obesity. On the contrary, bariatric surgery has proven to be the most effective long-term weight loss strategy in obese women in reproductive age. In this review we analyzed the more recent papers describing pregnancy outcome after bariatric surgery. In particular, we focused on weight loss procedures and their potential effects mainly on maternal complications, so to give a comprehensive view of the benefits and risks of post-surgery pregnancy. The present review is structured introducing the pros and cons associated with various surgical procedures, then analyzing the differences in maternal outcomes among pregnant women previously undergone bariatric surgery or not and finally concluding with a focus on the post-surgery clinical management aimed to reduce surgical complications, which may occur during future pregnancies. We concluded that outcome of pregnancy is favorable after bariatric surgery. However, the low number of patients in some studies and the fact that the vast majority of the observations have been performed retrospectively, resulting in errors in matching with the control groups, severely limits the reliability of the conclusions drawn. We highlighted the risks associated with various types of bariatric surgery, stressing the optimization of the screening procedures for nutritional deficiencies and counseling on correct weight gain and nutrition for a successful pregnancy. This aim needs to be achieved with the collaboration of a multidisciplinary team of specialists that work before, during and after delivery.

Transnational Trade in Human Eggs: Law, Policy, and (In)Action in Canada

In this paper, we provide as accurate a picture as possible of transnational trade in human eggs involving Canadians. We explain the legal status in Canada, and call for reform in the regulation, of such trade.

Pilot testing of checklists to discern adverse drug reactions and adverse drug events

ObjectiveTo estimate the prevalence of patient-reported adverse drug events (ADEs)/adverse drug reactions (ADRs) in the community pharmacy setting and determine the prevalence relative to pharmacist judgment. Data sourcesThe 2009 version of thePharmacy Times top 200 drugs was used to identify the prescription medications most commonly used within the ambulatory population during 2008. All ADEs/ADRs for each medication were obtained by combining the ADEs/ADRs listed inDrug Facts and Comparisons, Lexi-Comp, and Micromedex. MethodsChecklists for each pharmacologic class within the top 200 medications (n = 51) were developed, with questions about the five most common ADEs/ADRs in each class. Ten community pharmacies administered the checklists. Patients requesting a prescription refill for a medication listed in the top 200 were asked to complete a class-specific checklist to determine ADEs/ADRs experienced in the previous 4 weeks. Upon completion, pharmacists engaged in routine counseling procedures, including a discussion of patient-reported ADEs/ADRs. Pharmacists indicated if they believed, based on their clinical judgment, whether the ADE/ADR reported was related to the medication. Results2,057 checklists were completed, with a total of 10,285 potential ADEs/ADRs. Patients reported 2,185 ADEs/ADRs (21.24%), with 755 (7.3%) definitively confirmed by the pharmacist as being related to their medication. ConclusionUse of these checklists resulted in the identification of previously unrecognized ADEs/ADRs in the community setting. Routine use of these short, patient-completed checklists may assist pharmacists in earlier identification of ADEs/ADRs, which can have a positive impact on patient safety across settings.

Structured shared decision-making using dialogue and visualization: A randomized controlled trial

ObjectiveThe aim of this study is to evaluate a method, “Counseling in Dialogue” (CD), developed to increase the quality of counseling in youth mental health. Decisional conflict was used as indicator of the quality of counseling and shared decision-making. Methods94 children aged 2–12 years were randomized into a CD group and a care as usual (CU) group. In a before-and-after design decisional conflict was measured using the decisional conflict scale (DCS) for parents (N=133) and the Provider Decision Process Assessment Instrument for therapists (PDPAI, N=20). 81 children had follow-up data. ResultsCompared with parents of the CU group, parents of the CD group reported significantly less decisional conflict after counseling (difference mothers: −0.38 (95%CI −0.56; −0.19), p<.001; fathers: −0.22 (95%CI −0.44; −0.01), p=.045). 98% of the mothers and 96% of the fathers in the CD group accepted the recommended treatment, compared to 71% (fathers) and 77% (mothers) in the CU group, p<0.05. Decisional conflict of the therapists was low in both groups after counseling (difference: −0.03 (95%CI −0.19; 0.14), p=.741). ConclusionThe counseling procedure significantly lowered decisional conflict of the parents and promoted the acceptance of the recommended treatment.

Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster‐randomized community trial

Tobacco use adversely affects oral health. Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented successfully. This study aimed to evaluate two interventions to enhance tobacco use prevention and cessation (TUPAC) counselling among oral health professionals in Finland. We used a cluster-randomized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists (n=73) and dental hygienists (n=22) in Finland. Educational intervention consisted of 1 day of training, including lectures, interactive sessions, multimedia demonstrations and a role play session with standard patient cases. Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling. TUPAC counselling procedures provided were reported and measured using an electronic dental records system. In data analysis, intent-to-treat principles were followed at both individual and cluster levels. Descriptive analysis included chi-square and t-tests. A general linear model for repeated measures was used to compare the outcome measures by intervention group. Of 95 providers, 73 participated (76.8%). In preventive counselling, there was no statistically significant time effect or group-by-time interaction. In cessation counselling, statistically significant group-by-time interaction was found after a 6-month follow-up (F=2.31; P=0.007), indicating that counselling activity increased significantly in intervention groups. On average, dental hygienists showed greater activity in tobacco prevention (F=12.13; P=0.001) and cessation counselling (F=30.19; P<0.001) than did dentists. In addition, cessation counselling showed a statistically significant provider-by-group-by-time interaction (F=5.95; P<0.001), indicating that interventions to enhance cessation counselling were more effective among dental hygienists. Educational intervention yielded positive short-term effects on cessation counselling, but not on preventive counselling. Adding a fee-for-service to education failed to significantly improve TUPAC counselling performance. Other approaches than monetary incentives may be needed to enhance the effectiveness of educational intervention. Further studies with focus on how to achieve long-term changes in TUPAC counselling activity among oral health professionals are needed.

Secured E-Counselling Framework Using Composite Web Services

In this paper, we proposed a Secured E-Counselling Framework using Composite Web services to enhance the counselling, which is fully works as an online. This framework will be a great relief to the students in terms of reporting, registration and searching the information about college and university. Moreover this software gives an overview of the entire institute in a sort interval time and will be also great help to University to manage in the whole counselling procedure by reduce their paper work and their time. Students counselling system for Engineering/MBA/MCA is conducted by face to face communication in between the student and staff. This is suitable only for the students who are nearer to that university which conduct counselling. But this system will not be a comfortable one for the students who are coming from long distance. To avoid this problem, attending the counselling through the online from their own place with proper authentication is proposed. This task is accomplished by Student Online Counselling system.

Mini-clinical evaluation exercise and feedback on postgraduate trainees in the emergency department: A qualitative content analysis

Mini-clinical evaluation exercises (mini-CEXs) have been successfully adapted as a formative and summative assessment tool for various different postgraduate medical programs. However, only a few studies have evaluated its use in the setting of an emergency department (ED). The purpose of this study was to examine the quality of feedback given by preceptors to postgraduate Year 1 (PGY-1) residents during mini-CEXs in EDs. This prospective observational study involved EDs at 20 teaching hospitals and comprised 893 mini-CEX encounters involving 230 PGY-1 trainees and 242 preceptors. All feedback forms, which contained three sections, namely “Positive Feedback,” “Negative Feedback,” and “Action Plan,” were assessed using qualitative content analysis techniques. A total of 734 mini-CEX sessions (82.2%) contained positive feedback, 507 (63.8%) contained negative feedback, 350 (39.2%) contained action plans, and 131 (14.7%) had no feedback. These written feedback comments could be structured into 1,877 coded items and grouped into seven domains of clinical competence. These were: (1) medical interviewing, (2) physical examination, (3) professionalism, (4) clinical judgment, (5) counseling, (6) organization/efficiency, and (7) clinical procedures. During feedback from the mini-CEXs in the ED setting, preceptors to the PGY-1 students tend to emphasize clinical judgment and seemed to pay less attention to facilitate the development of reflective skills and communication skills.

The Impact of a Voice Counseling Procedure to Select Students With Normal Vocal Characteristics for Starting a Master Program in Speech Language Pathology: A Pilot Study

The purpose of this study is to determine objective vocal quality, vocal characteristics, and vocal habits in future speech language pathology (SLP) students and to evaluate the possible impact of a provided vocal counseling procedure. A comparison of vocal data was done in SLP students who had and who had not undergone vocal counseling procedure. It is hypothesized that counseling results in good vocal quality, adequate vocal performance, and appropriate vocal hygiene. Randomized controlled study design. To determine the vocal quality, questionnaires (Voice Handicap Index [VHI]), subjective (videostroboscopic and perceptual evaluations), and instrumental assessment techniques (aerodynamic, vocal range, acoustic measurements, Dysphonia Severity Index [DSI]) were used. Identical voice assessments were made in 71 students who followed and have not (n=83) followed the vocal counseling procedure. The VHI showed the absence of a psychosocial impact of the vocal quality. Thirty percentage of the subjects mentioned hoarseness as the most common vocal complain. Videostroboscopic evaluations revealed normal vocal anatomy and physiology. A significant difference regarding the DSI value was found between the students with (+3.3, 83%) and without (+1.8, 68%) a followed voice counseling procedure. This vocal counseling procedure is added as a standard procedure when future students gain information about the SLP master program. To what extent the presence and content of the vocal education strategy can influence the choice of the profession as an SLP is subject for further research.

ANRS–COM'TEST: description of a community-based HIV testing intervention in non-medical settings for men who have sex with men

ObjectiveTo describe a community-based HIV testing programme.Design and settingAn intervention of HIV voluntary testing conducted in non-medical settings in four French cities.ParticipantsMen who have sex with men (MSM).InterventionCounselling and rapid...

Münchner Modell der Früherkennung und Frühen Hilfen für psychosozial hoch belastete Familien

The prevention program “Munich Early Recognition and Intervention Model” is a project to provide systematic early and preventive support for infants and toddlers in families under high-level psychosocial stress. Responsible for its initiation and management is the Child Welfare and Health Department of Munich, Germany. The quality of the support for families has been evaluated. An individual adaptation of the counseling procedure for the special needs of the families and the application of a wide range of individual support measures for young families was shown. The effectiveness of the model was affirmed via several assessments, including the assessment of increased parental sensitivity and increased parental global assessment of functioning. These data are limited due to the fact, that they are currently based solely on the information given from the help providers on their own. The Munich Model is one of the few prevention projects in Germany, which actually includes the improvement of the early parent-child-relationship.

Developing and piloting an expert system for better routine voluntary HIV counseling and testing in China: preliminary results and lessons

This study aims at developing and testing a pragmatic expert system for HIV voluntary counseling (VCT-ES) that leverages best practices. The VCT-ES was developed via evolutionary prototyping and piloted in 10 voluntary HIV counseling and testing (VCT) clinics from Anhui and Beijing representative of prefecture and county level VCT clinics in China. All counselors with the clinics and the clients to the clinics within selected two weeks at baseline and the end of study were invited to participate. Assessment measures included essential counseling procedures (ECPs); clients' satisfaction, knowledge, and behavior efficacy. VCT-ES was developed which tries to model and facilitate standard VCT operation procedures and best practices. One hundred and eighty-two (96 at baseline vs. 86 after intervention) cases recordings, 172 (96 vs. 76) client questionnaires, 10 counselor, and 2 expert rating instruments were collected; and 17 clients and 8 counselors participated in qualitative interviews. VCT-ES increased delivery of ECPs from 18.94% to 66.39% on average; increased clients' knowledge from 40.51% to 86.34% and self-efficacy by 22.42%. The VCT-ES applications listed were rated 9.1 on average (maximum = 10). The VCT-ES could be an easy and effective solution to better routine VCT and merits further research.

Universal voluntary HIV testing in antenatal care settings: a review of the contribution of provider‐initiated testing &amp; counselling

To assess the contribution of provider-initiated testing and counselling (PITC) to achieving universal testing of pregnant women and, from available data on components of PITC, assess whether PITC adoption adheres to pre-test information, post-test counselling procedures and linkage to treatment. Systematic review of published literature. Findings were collated and data extracted on HIV testing uptake before and after the adoption of a PITC model. Data on pre- and post-test counselling uptake and linkage to anti-retrovirals, where available, were also extracted. Ten eligible studies were identified. Pre-intervention testing uptake ranged from 5.5% to 78.7%. Following PITC introduction, testing uptake increased by a range of 9.9% to 65.6%, with testing uptake ≥85% in eight studies. Where reported, pre-test information was provided to between 91.5% and 100% and post-test counselling to between 82% and 99.8% of pregnant women. Linkage to ARVs for prevention of mother to child transmission (PMTCT) was reported in five studies and ranged from 53.7% to 77.2%. Where reported, PITC was considered acceptable by ANC attendees. Our review provides evidence that the adoption of PITC within ANC can facilitate progress towards universal voluntary testing of pregnant women. This is necessary to increase the coverage of PMTCT services and facilitate access to treatment and prevention interventions. We found some evidence that PITC adoption does not undermine processes inherent to good conduct of testing, with high levels of pre-test information and post-test counselling, and two studies suggesting that PITC is acceptable to ANC attendees.

Pseudohypoparathyroidism: Diagnosis and Treatment

The term pseudohypoparathyroidism (PHP) indicates a group of heterogeneous disorders whose common feature is represented by impaired signaling of various hormones (primarily PTH) that activate cAMP-dependent pathways via Gsα protein. The two main subtypes of PHP, PHP type Ia, and Ib (PHP-Ia, PHP-Ib) are caused by molecular alterations within or upstream of the imprinted GNAS gene, which encodes Gsα and other translated and untranslated products. A PubMed search was used to identify the available studies (main query terms: pseudohypoparathyroidism; Albright hereditary osteodystrophy; GNAS; GNAS1; progressive osseous heteroplasia). The most relevant studies until February 2011 have been included in the review. Despite the first description of this disorder dates back to 1942, recent findings indicating complex epigenetic alterations beside classical mutations at the GNAS complex gene, pointed out the limitation of the actual classification of the disease, resulting in incorrect genetic counselling and diagnostic procedures, as well as the gap in our actual knowledge of the pathogenesis of these disorders. This review will focus on PHP type I, in particular its diagnosis, classification, treatment, and underlying molecular alterations.

Effectiveness of Smoking Cessation and Reduction in Pregnancy Treatment (SCRIPT) methods in Medicaid-supported prenatal care: Trial III.

This two-phase evaluation documented the delivery and effectiveness of evidence-based health education methods by regular staff to pregnant smokers. During Phase 1, a total of 436 Medicaid patients were screened and 416 (95%) gave consent: 334 nonsmokers and 102 smokers. This historical Comparison (C) group was assessed to document the "normal" pretrial smoking prevalence, patient nondisclosure (deception), and cessation rates at the first prenatal visit and during care. After this study, a formative evaluation of SCRIPT methods was conducted among 139 experimental group patients and 126 control group patients. During Phase 2, a total of 6,514 patients were screened over a 36-month period: 1,736 (27%) were smokers and 1,340 (77%) gave consent. After randomization, 247 became ineligible. The remaining 1,093 smokers received brief routine advice to quit. The experimental group (n = 544) also received a Commit to Quit video, A Pregnant Woman's Guide to Quit Smoking, and counseling. Self-reports and saliva were collected at baseline, ≥60 days, and ≤90 days postpartum for cotinine analyses to document cessation and significant reduction (SR) rates. The Phase 1 formative evaluation documented a 24% nondisclosure rate at the onset of care. It also confirmed a significantly higher experimental (17.3%) versus control group (8.8%) cessation rate and experimental versus control group SR rates of 22% and 16%. During Phase 2, unplanned policy changes, and delivery of experimental group counseling procedures to 15% to 20% of control group patients, resulted in a final experimental group cessation rate of 12% and a control group rate of 10%. The experimental group SR rate of 18%, however, was significantly higher than the control group SR rate of 13%. Effectiveness varied by the stability of clinic infrastructure, and degree of fidelity of staff performance of assessment and intervention procedures. The methods and results of this study will assist future health education programs for pregnant smokers to plan and conduct process and impact evaluations in prenatal care.

Sentinel Lymph Node Biopsy or Nodal Observation in Melanoma: A Prospective Study of Patient Choices

There is no consensus regarding the therapeutic utility of sentinel lymph node biopsy (SLNB) versus that of nodal observation (NO) in melanoma. To prospectively evaluate a standardized counseling procedure and its effect on patient choices to undergo SLNB or NO. In four centers, patients with melanoma eligible for SLNB or NO received a complete counseling procedure that included verbal information from dermatologists and surgeons, a detailed information sheet, and a written consent form. Data collected included patient and tumor characteristics, counseling conditions, and specialties of informing doctors. Factors influencing patients' choices were studied using multivariate analysis. Of 343 consecutive patients, 309 were offered SLNB and NO and received complete verbal and written information from a dermatologist alone (62%) or in association with a surgeon (38%). Approximately half took advice from trusted persons, and half asked for additional time before making a decision; 268 (86.7%) ultimately decided to undergo SLNB. Multivariate analysis showed that older patients, those with a head and neck melanoma, and those informed without a surgeon present were more likely to prefer NO. This counseling procedure was easily implemented in clinical practice. Patients favored SLNB but were able to understand uncertainties and express preferences.