Medical Counselors Research Articles

Newborn Screening and Clinical Profile of Children With Sickle Cell Disease in a Tribal Area of Gujarat

To present the result of newborn sickle cell disease (SCD) screening and clinical profile of SCD newborns in a tribal area of Gujarat. We screened all newborns of sickle cell trait (SCT) and SCD mothers for SCD using high-performance liquid chromatography (HPLC) within two days of birth at a secondary care hospital in a tribal area in Gujarat from 2014 to 2019. Newborns with SCD were registered under an information technology based platform for hospital-based comprehensive care. Neonates were followed prospectively every 3 months. If they missed the clinic visit, a medical counsellor visited them at home to collect the required information. Out of 2492 newborns screened, 87 (3.5%) were diagnosed with SCD. Among the 67 newborns screened for alpha-thalassemia deletion, 64 (95.4%) of babies had alpha-thalassemia deletion. We recorded total 554 clinic visits over the period of 221.5 person-years. The rates of acute febrile illness, painful crisis, hospitalization and severe anemia were 42.9, 14.9, 14.9 and 4.5 per 100 person-year, respectively. Two deaths were recorded, and 5 babies (5.7%) had severe SCD. We found a high prevalence of alpha thalassemia deletion among newborn SCD cohort in tribal area of Gujarat, and 70% babies had atleast one clinical complication on follow-up.

The Impact of Rare Genetic Disorders on Family Functioning

The increasing presence of genetic neurodevelopmental disorders (NDDs) results in greater demands for counseling. Many studies focus on the characteristics of patients, but less on family functioning. The aim of this study is to objectify parental stress and to study its relationship with child characteristics and environmental factors across several syndromes. 56 individuals with NDD participated: 24 with Kleefstra Syndrome, 13 with Koolen-de Vries Syndrome, and 19 with other rare (mono) genetic disorders. Parents were asked to complete the General Functioning subscale of the Family Assessment Device (FAD-GF), the Child Behavioral Checklist, and a questionnaire about demographic parental data. 25.5% of the families scored above the cut-off for pathological stress (>2.17). The mean FAD–GF score was 1.84. There was no significant difference between mean FAD-score of the subgroups (p=0,70). (Para)medical counselors should address this high amount of parental stress during counseling and consider these genetic syndromes as complex chronical illnesses.

The Excellence of Pharmacy Practice.

Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today's pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs.

Medical expert witness testimony in France and in Europe.

Health care professionals are usually at a loss when it comes to medical "complaints", essentially because they lack knowledge with regard to existing litigation procedures. After a short reminder of the different rights of appeal in France, we describe how medical appeals function in other European countries. Next, we give the details of how the evaluation of claims of bodily damage works, a process in which every physician may be called upon to participate several times in a career, either as the defendant, or as a medical counselor, or as an expert. The goal of this update is to understand the different compensation appeal circuits available to patients and help the surgeon demystify and dedramatize the situation while preparing for the medical expert witness testimony. All such testimony reports, via whatever appeal circuit, follow a similar procedure, even if they are not exactly identical.

The Excellence of Pharmacy Service: Past, Present and Future

Pharmacy education continues to evolve to better prepare pharmacists for their roles and responsibilities in an increasingly complex health care environment with advanced patient health needs. Another important factor is the pharmacists themselves. Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs. All people who take medications are at risk of actual or potential drug therapy problems. These problems are a significant source of morbidity and mortality when left undetected and unresolved and drive huge costs across the health system. As drug therapy experts, pharmacists provide drug therapy management services built around a partnership between the pharmacist, the patient (or his or her caregiver), physicians and other members of a patient’s health care team.

Two decades of risk factors and transfusion-transmissible infections in Dutch blood donors.

Risk behavior-based donor selection procedures are widely used to mitigate the risk of transfusion-transmissible infections (TTIs), but their effectiveness is disputed in countries with low residual risks of TTIs. In 1995 to 2014, Dutch blood donors infected with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), or syphilis were interviewed by trained medical counselors to identify risk factors associated with TTIs. Trends in the prevalence and incidence of TTIs were analyzed using binomial regression models. A total of 972 new donors and 381 repeat donors had TTIs. New donors had higher rates of TTIs compared to repeat donors. Although the HBV and HCV prevalence gradually decreased over time, the incidence of all five TTIs remained stable during the past two decades. In new donors the TTIs had the following risk profiles: "blood-blood contact" for HCV, "unprotected sex" for HIV and syphilis, and "country of birth" for HBV and HTLV. In infected repeat donors, sexual risk factors predominated for all TTIs. At posttest counseling, 28% of infected repeat donors admitted to risk factors leading to permanent donor exclusion if revealed during the donor selection procedure (predominantly male-to-male sex and recent diagnosis of syphilis). The prevalence and incidence of TTIs among Dutch blood donors are six- to 60-fold lower than in the general Dutch population, illustrating the effectiveness of donor selection procedures. However, at least a quarter of infected donors appeared noncompliant to the donor health questionnaire (DHQ), suggesting that DHQs, or the way donor questioning is implemented, can be improved.

Counselling in multiple endocrine neoplasia syndromes: from individual experience to general guidelines

Counselling of patients and closely related family members has to take a central place in management of hereditary diseases, like multiple endocrine neoplasia (MEN) syndromes including von Hippel-Lindau (VHL) disease. In the strategy of health care, preventive medicine such as periodic clinical examination of families at-risk needs a high priority, because in general it is assumed that continuity in attendance is cost-effective. Counselling has to be based on individual medical experience of the doctor, adjusted to common guidelines and the findings in the family. Information leaflets, appropriate outpatient departments and an extensive network of specialists will facilitate continuity in care. Flow diagrams involving practical guidelines for diagnosis, treatment and follow up need to be applicable and after adjustment, should be accepted generally. Specially trained paramedics for counselling are required as a network that will guarantee periodic clinical examination and secure optimal prevention. Such paramedics will coordinate nationwide multidisciplinary guidance, and organize preventive and emergency cure for these patients. They will be supervised by expert clinicians in the field, and collaborate with specialists for social and psychological issues, patient organizations and clinical genetic centres. All of these professionals are responsible together for providing patients with up to date clinical information (via newsletters, Internet, etc.). Recently, in the Netherlands, a project was initiated to guarantee continuity in care and study the delivery of care. In order to realize this plan, funding has to be provided in the current research programme. In a future system support has to be obtained on a continuous base, preferably by the government and health care insurers and supervised by the national institute for health care.

Complaints that predict drop-out from a detoxification and counselling unit

Sixty-one consecutive clients in a multidrug addiction detoxification and counselling unit were interviewed by their medical counsellor about bodily pain, distress, and coherence in their life. Clients who did not complete the 3-week postdetoxification program reported a higher level of fatigue and difficulties with concentration compared with completers. Antonovsky’s Sense of Coherence test showed less favourable values in noncompleters than in completers. No significant difference was found on the Hopkins Symptom Checklist. Factor analysis showed that both pain and emotional distress belonged to one dimension. Fatigue was the symptom that predicted drop-out when adjusting for other complaints and background factors.

The need for multidisciplinary training in counseling the medically ill: Report of the training committee of the Linda Pollin Foundation

Training for medical counselors requires that medicine and psychiatry give up the position that counseling is only a negligible offshoot that almost any professional can readily do. Instead, counseling can be considered a generic concept that covers a wide variety of interventions designed to help patients cope with the complications and consequences of their chronic illness. This report outlines the principles and scope of training for consideration in the area of counseling the medically ill and reviews the current status of training programs in the fields of psychiatry, psychology, social work, and nursing. Recommendations are made for future directions, including role clarification for disciplines, building a credible research base, provision of guidelines and possible accreditation, and incorporating medical counseling into training fellowships.

The other side: counselor roles.

The problem of treating a narcotic-dependent person is probably one of the most difficult confronting those attempting to provide rehabilitation services. Often emphasis has been placed on those persons receiving the services provided rather than those who provide them. In this paper the drug counselor is focused upon, for after all it is he or she who plays the many roles necessary to accomplish this task at hand. The roles include psychotherapist, crisis intervention agent, medical counselor, and client advocate for the addict in treatment. Behaviors, expectations, and responsibilities involved in these counselor roles influence the development of a "healing partnership" involving both the counselor and the client.

Hans Nielsen, 1898-1951

Hans Nielsen, formerly colony manager at Thule, northwest Greenland, was killed in a traffic accident in Copenhagen on 4 September 1951. Hans Rudolf Johannes Emil Nielsen was born in the village of Qaersut, Umanak district, west Greenland, on 19 March 1898. When he had completed his education in Denmark, his relative and close friend, Dr. Knud Rasmussen, put him in charge of the trading post at Thule, where he served for more than twenty years. Hans Nielsen's work in Thule has been of immeasurable importance to the Eskimo population of the district. His unfailing sense of justice and fairness gave him undisputed authority both among white men and among natives. He was thereby able to keep up the morale of the Eskimo by preserving the most valuable of the old tribal customs and to enlist their full cooperation in the enforcement of the game laws, a matter of vital importance after the introduction of firearms. As long as Hans Nielsen was in Thule, the natives were spared most of the difficulties that ordinarily beset primitive people on their first contact with Western civilization. Many Danish, American, and British expeditions, which visited Thule between the two World Wars, have enjoyed the boundless hospitality of Mr. and Mrs. Nielsen. Hans Nielsen was a practical man with a thorough knowledge of his district, and his advice has saved many an inexperienced traveler from difficulties, if not from disaster. In 1941 Hans Nielsen left Thule to accept a position as colony manager in Egedesminde, and later moved to Godhavn. A few months before his death he had retired because of failing health and had planned to settle in Denmark. Hans Nielsen is survived by his wife, a son and a daughter, and by his mother, who after the death of her first husband married Dr. Alfred Bertelsen, Medical Counselor to the Greenland Administration.

Psychological service at the Los Angeles Institute of Family Relations.

Describes the Institute of Family Relations which was established in Los Angeles to serve as an educational center and information bureau, in connection with problems of sex, heredity, marriage, and parenthood. Much of its work is necessarily psychological, though the Institute is built on a broad scientific foundation. It deals only indirectly with medical or legal problems. The work of the Institute embraces three departments: research, public education, and personal service. An integral part of the latter is the psychological service, under the direction of the writer, and in collaboration with the Southern California Society for Mental Hygiene. The Institute considers its premarital service to be the most constructive work it does. This is intended to make up the deficiencies in the ordinary young person's education for marriage. It includes a study of the personal and family history and a physical examination in the office of one of the Institute's medical counselors, as well as educational preparation and a study of the personality. A large part of the Institute's daily work is the counseling of persons with marital difficulties of one kind or another.