Joint Consultation Research Articles

Fertility and sexuality in the spinal cord injury patient.

After a spinal cord injury, patients have different perceptions of sexuality, sexual function, and potential for fertility. These changes can greatly impact quality of life over a lifetime. The purpose of this workgroup was to identify common evidence based or expert opinion themes and recommendations regarding treatment of sexuality, sexual function and fertility in the spinal cord injury population. As part of the SIU-ICUD joint consultation of Urologic Management of the Spinal Cord Injury (SCI), a workgroup and comprehensive literature search of English language manuscripts regarding fertility and sexuality in the spinal cord injury patient were formed. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for levels of evidence (LOEs) and grades of recommendation (GORs). Genital arousal, ejaculation, and orgasm are significantly impacted after spinal cord injury in both male and female SCI patients. This may have a more significant impact on potential for fertility in male spinal cord injury patients, particularly regarding ability of generate erection, semen quantity and quality. Female patients should be consulted that pregnancy is still possible after injury and a woman should expect resumption of normal reproductive function. As a result, sexual health teaching should be continued in women despite injury. Pregnancy in a SCI may cause complications such as autonomic dysreflexia, so this group should be carefully followed during pregnancy. By understanding physiologic changes after injury, patients and care teams can work together to achieve goals and maximize sexual quality of life after the injury.

Surveillance and management of urologic complications after spinal cord injury.

Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management. This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs). At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population. There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.

De la pédiatrie à la médecine adulte : transition des patients drépanocytaires, une étude monocentrique française

Sickle cell disease, a hemoglobin disorder with autosomal recessive transmission, is one of the most common genetic diseases screened in France. Thanks to early management, 95% of sickle cell patients reach adulthood and require transition from pediatric care to adult care. Through a retrospective study of records from serious sickle cell patients over 17 years old, followed in the hematology-oncology pediatric unit of Reims University Hospital Center in France, we analyzed transition conditions, compared pediatric and adult management, and proposed a plan for transition care. As of 1 January 2016, out of 19 sickle cell patients meeting the inclusion criteria, 12 had made the transition from pediatric care to adult medicine. Among the transition group, the transition was proposed by the pediatrician in 92% of cases. The average age of transition was 19.4 years. The time between receiving the information and the last pediatric visit was 2.4 months. Seven out of the 12 patients were informed of their transition during the last pediatric visit. The age of the first adult visit was 20.3 years. There was no alternate or joint consultation. The treatments prescribed during the last pediatric visit were not modified during the first adult visit. The average number of hospitalizations per patient was 2.7 in pediatric care and 3.4 in adult care with a median value of 2 in both groups. Three out of 12 patients died, the average age of death being 26.7 years. Transition is an important milestone in chronic disease patients. More than age, the maturity of the patient must be taken into account. The transition to the adult structure requires early preparation in the teenage years and investment of the adolescent and his family as well as investment of pediatric and adult caregivers. This study points out the need to establish a transition plan within our hospital in collaboration with adult physicians. Continuity of care is necessary to increase the quality of managing patients and cannot be done without a close relationship between pediatric specialists and adult physicians.

Prescribed medications

According to NHS England, the NHS spends around £570 million a year on prescriptions for medicines that can be purchased over the counter (OTC). It has therefore launched a joint consultation with NHS Clinical Commissioners on commissioning guidance for conditions for which OTC items should not be prescribed routinely in primary care.

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Using new, rich data on a representative sample of British workers, we examine the relationship between joint consultation systems at the workplace and employee satisfaction, accounting for possible interactions with union and management-led high-commitment strategies. We focus on non-union employee representation at the workplace, in the form of joint consultative committees (JCCs), and the potential moderating effects of union representation and high-involvement human resource (HIHR) practices.Our findings suggest a re-evaluation of the role that JCCs play in the subjective well-being of workers even after controlling for unions and HIHR policies. There is no evidence in our estimates of negative interaction effects (i.e., that unions or HIHR negatively influence the functioning of JCCs with respect to employee satisfaction) or full mediation (i.e., that unions or HIHR are substitutes for JCCs when it comes to improving self-reported worker well-being).If anything, there is a significant and positive three-way moderating effect when JCCs are interacted with union representation and high-involvement management. This is the first time – to the authors' knowledge – that comprehensive measures of subjective employee well-being have been estimated with respect to the presence of a JCC at the workplace, whilst controlling for workplace institutions that are themselves designed to involve and communicate with workers.

An action-oriented study on developing effective collaboration between primary care and welfare in the promotion of mental health in patients with multi-problems

Introduction: Many patient who presents themselves with mental health complaints to a general practitioner (GP) also suffer from problems in other domains. Consequently, many of these multi-problem patients qualify for health care as well as social welfare. Since 2015, social welfare professionals in most municipalities in the Netherlands work organized in so called 'area-based social welfare teams' (SWTs). This is linked to the ‘Triple Aim’ which entails reduced healthcare expenditure, improved satisfaction with care and perceived health and asks for more intense and new forms of collaboration between healthcare and social welfare professionals. However, collaboration between a GP facility and the local SWT is in most municipalities in the Netherlands, including Nijmegen, not self-evident. Aim of this action- oriented study is to develop a blueprint and implementation plan for optimal and efficient collaboration between general practitioners (GPs) and a SWT in order to employ an integral and preventive approach for people with mental health complaints and problems in different life domains. Methods: Setting for the current study, with a duration of 24 months, is the district of Lindenholt in the city of Nijmegen where the prevalence of psychiatric diagnoses and mental health symptoms are highest of Nijmegen. All relevant stakeholder have committed themselves to a joint trajectory with the ambition to improve the health of residents of Lindenholt by an effective and efficient integration of healthcare and social welfare and an optimal person-oriented and preventive approach. For this study a multi-method approach with a mix of qualitative, quantitative and action-oriented research is used. Two main components can be distinguished: 1. Qualitative and quantitative research to explore the baseline and follow-up level of quality of integrated care (ICE-Q), facilitating factors for better collaboration between GPs and SWT and to evaluate the to be developed work format. 2. Action-oriented research in which professionals from a GP facility and SWT experiment with a new work format for collaboration using three cycles of ‘plan-do-check/evaluate-act’ resulting in a blueprint and implementation plan for collaboration between primary health care and social welfare. Thirty patients with mental health complaints in combination with problems in other domains and who receive a high level of care by both the GP and the SWT (‘high users’) will be selected for an experimental work format of collaboration like a joint consultation. Preliminary results: on the quantitative and qualitative baseline findings on the level of integrated care and perceived barriers and facilitating factors for collaboration will be presented at the conference. Lessons already learned: - Instead of jumping to an intervention, invest in getting to know your collaborators and work out the details of how you want to communicate and collaborate first. - Experienced barriers for effective collaboration are often not work-related but emotional. - Don’t assume you share the same vision but explicate a shared one. - Innovation starts with visionary health professionals, but if the conditions for implementation are not well organized (e.g., financial support or extra hours), integral collaboration stagnates.

An insight into the patient's response to a diagnosis of urological cancer

A cancer diagnosis and the patient's response to the news pertains to all types of cancer, however, in this article, the focus is on urological cancer. Intrinsic to the management of this patient group is the urology multidisciplinary team, in which the role of the cancer nurse specialist (CNS) is pivotal. For most people, a cancer diagnosis is arguably their worst fear. It is therefore prudent that a holistic approach is used when determining care and ensuring that appropriate support is forthcoming. This necessitates an assessment of the physical, psychological/emotional, psycho-social, spiritual and cultural components of the individual's healthcare needs, and accordingly, devising a plan of care to secure the best outcomes. This article concentrates on the psychological/emotional component. It outlines a case study of a patient's response to the consultant's question in the joint consultation clinic, examines the CNS's interpretation and understanding of the events, and her perspective on whether factors such as fear, anxiety and distress influence the individual's response to the diagnosis, their comprehension of information and the messages relayed, and consequently, their ability to manage the ensuing issues. It also looks at the support available to cancer patients following the receipt of a cancer diagnosis and its efficacy in addressing their concerns. Integral to this is effective communication, specifically the timely provision of information by health professionals.

Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

BackgroundManagement of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients.Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared.ResultsFirst 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician.ConclusionJoint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients.Disclosures All authors: No reported disclosures.

GPs\u2019 and child and adolescent psychiatry specialists\u2019 experiences of joint consultations in the GP\u2019s office: a qualitative study

BackgroundThe study is an exploration of a joint consultation model, a collaboration between general practitioners (GPs) and specialists from child and adolescent mental health services (CAMHS) in Lillehammer, Norway.MethodsA qualitative study based on two focus group interviews, one with participating GPs and one with participating specialists from the local CAMHS. Participants were five GPs, with work experience varying from 6 months to 20 years (four of them specialists in general medicine) and two CAMHS specialists—a psychiatrist and a psychologist—both with more than 20 years of experience.ResultsThe focus group discussions revealed that both GPs and CAMHS specialists saw the joint consultations as a good teaching method for improving GPs’ skills in child and adolescent psychiatry. Both groups believed that this low-threshold service benefits the patients and that the joint consultation is especially suited to sort problems and determine the level of help required.ConclusionsThe GPs and CAMHS specialists shared the impression that the collaboration model is beneficial for both patients and health care providers. Close collaboration with primary health care is recommended in the guidelines for child and adolescent psychiatry outpatient clinics. We suggest that the joint consultation model could be a good way for GPs and CAMHS specialists to collaborate.

Independent prescriber physiotherapist led balance clinic: the Southport and Ormskirk pathway.

To report the introduction and impact of non-medical prescribing, initiated to improve patient pathways for those presenting with dizziness and balance disorders. The Southport and Ormskirk physiotherapy-led vestibular clinic sees and treats all patients with dizziness and balance disorders referred to the ENT department. Letters are triaged by an audiologist, who also performs an otological examination and hearing test; this is followed by an assessment with the independent prescriber physiotherapist. An ENT consultant is nearby if joint consultation is needed. Diagnoses, treatments and patient satisfaction were studied, with an analysis of the impact of medication management (stopping or starting medicines) on patients and service. In 12 months, 413 new patients with dizziness and balance disorders had appointments. The most common diagnoses were benign paroxysmal positional vertigo and vestibular migraine. Eighty-four per cent of patients required self-management strategies, 50 per cent exercise therapy, 48 per cent medication management and 24 per cent a particle repositioning manoeuvre. Patient satisfaction was high (99 per cent). Having an independent prescriber physiotherapist leading the balance clinic has reduced the number of hospital visits and onward referrals. Nearly half of all patients required medication management as part of their dizziness or balance treatment.

Impact of joint consultation by a clinical pharmacist and a clinical geriatrician to improve inappropriate prescribing for elderly patients

ObjectiveAppropriate prescribing is a key quality element in medication safety. It is unclear if therapeutic interventions resulting from medication review lead to clinically relevant improvements. The effect of medication review...

Development of Processes and Procedures in a Hospital Social Work. Department and Evaluation of their Impact across the Healthcare Continuum

In a tertiary hospital, social workers provide frontline services to all hospital departments and to patients with all kinds of social pathologies. This wide range of activity is challenging and demanding. In order to facilitate and improve functionality of the team by managing patient flow, in 2012 we designed and implemented a stratetgy of generic social work processes and specific procedures. First, we studied the route patients follow in the hospital in order to design the generic process. We listed all the procedures needed and defined a series of operative, strategic, administrative and support resources, both external and internal, linked to the processes and procedures. We then identified the sources of entrance to the social work unit and screened patients to determine social risk factors . Psychosocial assessment , social needs and social intervention were determined. Following joint consultation with the patient and the medical team, we determined where patients would be transferred for follow up after discharge. The development of this strategy helped the social workers to minimize or avoid dispersion and to tailor the optimal route that each group of patients should follow while in hospital. We were also able to determine the most significative internal and external resources, allowing us to manage and organize the demands of our services. The implementation of this method of generic social work processes and specific procedures has enabled us to define the care continuum and work in a more linear manner, focusing on patients’ real needs.

A Principles-Based Response to the Proposed Reform of the Governance Structure for Listing Regulation in Hong Kong

The June 2016 joint consultation on listing regulation arises out of a renewed concern to ensure the Hong Kong market remains fit for purpose in meeting current and emergent challenges and demands. This paper undertakes an analysis of the consultation applying a law and principles based approach. This approach requires the listing regime to be suitable not only in view of market conditions but also in view of internationally accepted practices and standards concerning regulatory oversight. While it is recognized that regulatory evolution requires progressive innovation, the two new SEHK sub-committees envisaged by the joint consultation give rise to several areas of concern. The reasons for implementing the changes proposed are not well explained in the consultation and no clear case is presented as to why the sub-committee structure would provide improvements. Putting the SFC into a frontline decision-making role is problematic under the current statutory framework, and is not necessarily a forward moving step toward a system of statutory listing regulation. It implements changes that bypass legislative intent and renders certain statutory laws meaningless, it may subject the SFC to corporate laws that would impact on its ability to act as an independent regulator, and it would diminish regulatory accountability and clarity. The risk that the changes could be regarded as legislation by regulation would weaken, not strengthen, the SFC’s regulatory mandate over public listings. These problems run counter to the intent of the Proposal to improve listing regulation and carry the risk that Hong Kong’s governance of listings, particularly the role of the statutory regulator in it, would be at odds with international best practices. The conclusion of this paper is that progressing with the sub-committee proposal would not be a positive development unless and until the issues identified in this paper are properly addressed and resolved. It is suggested that a more holistic view of market development needs to be adopted that extends beyond the decision making mechanisms of the dual filing regime and identifies more precisely the specific issues that are problematic. Doing so would permit more targeted and sustainable oversight mechanisms to be developed.

Psychomotor education and speech therapy when weaning a child off artificial feeding

To support children and their families with weaning off artificial nutrition, a psychomotor therapist and speech therapist from the 'Pierre Robin syndrome and congenital sucking-swallowing disorders' specialist rare disease centre at Necker-Enfant Malades hospital in Paris, have set up a joint consultation, as a complement to medical consultations. This programme shows how speech therapy and psychomotor education can complement each other in order to help children and their parents during this difficult period.

Update of the ICUD-SIU consultation on upper tract urothelial carcinoma 2016: treatment of localized high-risk disease.

To provide a comprehensive overview and update of the joint consultation of the International Consultation on Urological Diseases (ICUD) and Société Internationale d'Urologie for the treatment of localized high-risk upper tract urothelial carcinoma (UTUC). A detailed analysis of the literature was conducted reporting on treatment modalities and outcomes in localized high-risk UTUC. An international, multidisciplinary expert committee evaluated and graded the data according to the Oxford System of Evidence-based Medicine modified by the ICUD. Radical nephroureterectomy (RNU) is the standard of treatment for high-grade or clinically infiltrating UTUC and includes the removal of the entire kidney, ureter and ipsilateral bladder cuff. The distal ureter can be managed either by extravesical or transvesical approach, whereas endoscopically assisted procedures are associated with decreased intravesical recurrence-free survival. Post-operative intravesical chemotherapy decreases the risk of subsequent bladder tumour recurrence. Regional lymph node dissection is of prognostic importance in infiltrative UTUC, but its extent has not been standardized. Renal-sparing surgery is an option for manageable, high-grade tumours of any part of the upper tract, especially of the distal ureter, as an alternative to RNU. Endoscopy-based renal-sparing procedures are associated with a higher risk of recurrence and progression. A multimodal approach should be considered in localized high-risk UTUC to improve outcomes. RNU is the standard of treatment in high-risk disease. Renal-sparing approaches may be oncologically equivalent alternatives to RNU in well-selected patients, especially in those with distal ureteric tumours.

The impact of joint consultation with family physicians on perception of psychologists.

The impact of joint consultation with family physicians on perception of psychologists.

How does justice smell? Reflections on space and place, justice and the body

Flowing from a joint consultation on Spatial Justice and Reconciliation on 21–22 September 2015, hosted by the Centre for Contextual Ministry and the Ubuntu Research Project of the University of Pretoria, this article reflects on the notions of space and justice from the perspective of a contemporary theological anthropology as ‘embodied sensing’, where the making of meaning is sensed in the body. The argument is put forward that spatial justice is an embodied endeavour and that it cannot be achieved disconnected from the bodies of the persons in the concrete context where justice is strived for and where bodies can flourish. The relation between spatial justice, sense of place, human flourishing and the embodied sensing of meaning is explored.

Introducing Union Representation and Its Complexities – A Case Study of the Royal Thai Civil Service

This paper deals with the result of the recognition under the ILO Conventions 87 and 98 of the freedom of association and subsequent introduction of union representation in the Royal Thai civil service. As a consequence, the Royal Thai Government has changed the Constitution to allow for union representation in its civil service. A decree has been drafted and focus groups have been interviewed to establish the views of a cross-section of civil servants on their expectations and desires in being allowed to form and join a union. The paper discusses the approach taken to union representation in terms of collective bargaining versus joint consultation and centralization versus decentralization and the discourse that has surfaced as a result of the interviews between the policy makers and civil servants, particularly with regard to its context of a high power distance culture. The analysis provides the best practice and effective approach to the introduction of union representation within the Thai Civil Service.

Partnership is alive and underpinning healthcare delivery

556 British Journal of Healthcare Management 2015 Vol 21 No 12 © 2 01 5 M A H ea lth ca re L td effective and enhanced performance and create a knowledge and understanding of employee aspirations with attention to the employee’s voice. The employee voice can be expressed in a number of ways and through a variety of two way channels, both cascading down and feeding back up through the most direct routes. Attitude surveys provide another commonly used channel, which is inherently flexible, but not interactive. Broad forms of employee voice include direct involvement in the way work is organised and indirect influence on decisions affecting the broader organisation through works councils or joint consultation committees (Bacon and Samuel, 2009). The employer’s organisational culture and management style impact directly on productivity and performance, and research has shown that employee relations similarly impact on performance. Herein lies the challenge, as key elements of good practice include job design, skills development, and a climate of regular, consistent consultation and involvement; and it is these areas which are highly contested. Theoretically, these areas are associated with good management practice that provides a positive psychological contract based on trust and fairness tied into an organisational culture that delivers positive outcomes linked to performance. In reality, a ‘blame culture’ is still prevalent in many areas of the NHS. When this partnership works, the effect at an employee level is commitment, job satisfaction, and a willingness to produce, but when it fails (for whatever reason) a perverse psychological contract develops, which is inevitably destructive. From an employee’s perspective, either version of this contract is subjective. Assessments of wellbeing at work are affected by a variety of factors including the nature of the work task, social integration in the workplace, participation in decision-making and job security, which link into the total experience of work. Although the contract is individual in nature, there will be work group-, departmentaland organisational-wide aspects, which imply that while structures and relationships adjust, the historical legacy may take time to change (McIntosh and Voyer, 2012). Within the NHS the promotion of partnership between employer, employee and trade unions has emerged as an inclusive mechanism, whereby union relevance is supportive of long-term interests of the Bryan McIntosh, senior lecturer in health management and organisational behaviour at the University of Bradford, explores the role of partnerships in the health service Partnership is alive and underpinning healthcare delivery

The changing nature of collective employment relations

Purpose – The purpose of this paper is to survey developments in four aspects of collective employment relations (ER) since the mid-1960s: collective representation and organisation; collective bargaining coverage and structure; the collective bargaining agenda; and joint consultation arrangements. It considers the reasons underlying change. Design/methodology/approach – A range of published sources are drawn on, including quantitative, survey based and qualitative, case-study and other evidence. Findings – The landscape of collective ER has changed markedly over the past half century. Membership of trade unions has fallen from around half of the workforce to one-quarter. Employers who mainly conducted collective bargaining through employers’ associations now negotiate, if at all, on a firm-by-firm basis. Collective bargaining coverage has sharply declined and now only extends to a minority of the private sector workforce. The bargaining agenda has been hollowed out. Joint consultation arrangements too are less widespread than they were around 1980. Originality/value – The paper contends that change has been driven by three underlying processes. “Marketization” of collective ER entailing a shift from an industrial or occupational to an enterprise frame of reference. The rise of “micro-corporatism”, reflecting increased emphasis on the common interests of collective actors within an enterprise frame. Finally, the voluntarism, underpinning Britain’s collective ER became more “asymmetric”, with employers’ preferences increasingly predominant.