Single Consultation Research Articles

La consultation unique en pédopsychiatrie pour les enfants d’âge préscolaire : intérêts et limites d’un modèle de réponse à des demandes exponentielles

IntroductionIn child psychiatry, the classic model of care, which is the therapeutic consultations, implies a continuity of care by the same therapist from the first session. The strong emotional charge which emerges from this first consultation favours the therapeutic alliance. This model requires staff resources which are often no longer available in our care systems. Depending on the area, children have to wait several months to several years to get a first appointment with a specialist. A Geneva outpatient child psychiatric unit for preschool children has experimented a different approach in which families are first seen by an experienced child psychiatrist for a single consultation (SC) with the following objectives: to reduce the waiting time before the first appointment, to relieve parental anxiety, to give initial advice and to refer families to care with another therapist if needed, either within the same unit or to another structure. ObjectivesIn this article, we examine, through an observational study, the relevance of this model, its acceptance by families and therapists, as well as its advantages and limitations. MethodsAn observational study was conducted between March 2019 and February 2020 among 79 families who benefited from this model. The data were collected in an outpatient child psychiatry unit for preschool children, the Guidance infantile, which is part of the Geneva University Hospitals. Exclusion criteria were: no French speaking, the presence of a legal third party during the session (minor protection service, lawyer), or a known clinical contraindication to a change of therapist. Four questionnaires were distributed along the study. The first and second were respectively completed by the family and the therapist immediately after the SC. The third was filled out by the family by telephone two months after the SC and the fourth was completed by the second therapist in charge of the therapy after the SC, if therapy took place in the same unit. ResultsAt the end of the 79 SCs, 41 indications for continuation of care in the Guidance were made, 26 of them also including a parallel referral to an outpatient care structure. 24 patients were referred only to outpatient care, and for 14 patients no further care was indicated or desired by the parents. The SCs lasted between 60 and 90minutes. Regarding their concern about their child, 65% of families noticed a reduction of anxiety immediately after the SC and 51% two months after the SC. 75% answered that the SC helped them to better tolerate the wait before the rest of the treatment. However, this waiting time was still perceived as too long by 22% of families. Most parents (51% after the SC and also after 2 months) perceived the change of therapist as “not problematic at all”. When the patient was redirected toward a junior therapist inside the same care unit, the written report and oral transmissions facilitated the follow-up. All of the second therapists considered that the change of clinician had no negative impact on the establishment of a therapeutic alliance. On the contrary, 63% of them noted that the SC had favored the alliance. ConclusionsGood clinical practice requires the development of therapeutic models that take into account their quality, effectiveness and cost effectiveness. The lack of child psychiatrists, together with the increase in needs, pushes us to think about new modes of care which take into account the particularity of child psychiatric care in which the therapeutic alliance constitutes a major stake. The results of this observational study show the relevance and acceptability of this model in a population of families seeking psychiatric help for preschool children. The families noted fare more advantages than inconveniences with this new practice. The majority of them appreciated the rapid management of care, which was more important to them than the continuity of care by the same therapist. The clinicians, who were mainly doubtful about this model, gave a positive evaluation, in particular by realizing that the therapeutic alliance was not negatively impacted by the change of therapist. However, this model should be applied with some flexibility by allowing a second session when clinically useful to improve the evaluation or the referral and by allowing the SC's therapist to continue the assessment and the treatment with families who are at risk of disruption of care if there is a change of therapist or an additional waiting period.

Hysterosalpingography is obsolete: hysterosalpingo-contrast foam sonography should be the alternative

Current evidence suggests that the hysterosalpingo-foam sonography test (HyFoSy) has emerged as a new option to make Fallopian tube assessment easier. Several published studies have compared the different types of tubal patency test available with the accepted gold standard, laparoscopy and dye, endorsing the advantages of HyFoSy over the other techniques. However, the authors wonder why professionals nowadays do not indicate HyFoSy as a first-choice diagnostic tool, with X-ray hysterosalpingography as still the most recommended procedure in outpatients. The aim of this article is to highlight the latest updates on this topic in order to raise awareness of the benefits of hysterosalpingo-contrast sonography as well as provide some tips for performing HyFoSy to obtain the maximum information in a single consultation.

A self-driven approach for multi-class discrimination in Alzheimer's disease based on wearable EEG

Early detection is critical to control Alzheimer's disease (AD) progression and postpone cognitive decline. Traditional medical procedures such as magnetic resonance imaging are costly, involve long waiting lists, and require complex analysis. Alternatively, for the past years, researchers have successfully evaluated AD detection approaches based on machine learning and electroencephalography (EEG). Nonetheless, these approaches frequently rely upon manual processing or involve non-portable EEG hardware. These aspects are suboptimal regarding automated diagnosis, since they require additional personnel and hinder portability. In this work, we report the preliminary evaluation of a self-driven AD multi-class discrimination approach based on a commercial EEG acquisition system using sixteen channels. For this purpose, we recorded the EEG of three groups of participants: mild AD, mild cognitive impairment (MCI) non-AD, and controls, and we implemented a self-driven analysis pipeline to discriminate the three groups. First, we applied automated artifact rejection algorithms to the EEG recordings. Then, we extracted power, entropy, and complexity features from the preprocessed epochs. Finally, we evaluated a multi-class classification problem using a multi-layer perceptron through leave-one-subject-out cross-validation. The preliminary results that we obtained are comparable to the best in literature (0.88 F1-score), what suggests that AD can potentially be detected through a self-driven approach based on commercial EEG and machine learning. We believe this work and further research could contribute to opening the door for the detection of AD in a single consultation session, therefore reducing the costs associated to AD screening and potentially advancing medical treatment.

The efficacy of single pharmacist medication review among type II diabetic patients who take six chronic medications or more: a case\u2013control study

BackgroundPharmacist medication review has been implemented in many health organizations throughout the world in an attempt to alleviate the underlying risk of polypharmacy in elderly patients. These consultations are often frequent and prolonged, and are thus associated with increased costs. To date, data regarding the most effective way to utilize pharmacist consultations for the improvement of health status is scant.AimTo evaluate the effectiveness of a single pharmacist consultation on changes in chronic medication regimes and on selected outcomes of diabetes 1-year after the consultation.MethodsA case–control study included an intervention group of 740 patients who had pharmacist consultations and a reference group of 1476 matched patients who did not have a pharmacist consultation. 1-year outcome measures were compared including changes in medications, improved safety, and objective variables such as Hba1c, blood pressure, and lipid profile.ResultsIn the pharmacist consultation group, there were significantly more treatment changes ([mean 1.5 vs. 0.7, p < 0.001 medications were stopped], and [mean 1.3 vs. 0.4, p < 0.05 medications were started]). Patient safety improved with a general reduction in opiates and benzodiazepines ([50.0% vs. 31.6%, p < 0.05 opioids were stopped] and [58.8% vs 43.8%, p < 0.001 benzodiazepines were stopped]). Sulfonylurea treatment reduced (10.7% vs. 3.6%, p < 0.05 patients who stopped Sulfonylurea) and Glucagon-like peptide-1 receptor agonists (GLP-1) increased (16.4% vs. 11.2%, p < 0.001 patients who started GLP-1). Additionally, HbA1c levels showed a small decrease in the pharmacist consultation group ([− 0.18 ± 1.11] vs. [− 0.051 ± 0.80], p = 0.0058) but no significant differences were found regarding blood pressure or lipids profile.ConclusionA single pharmacist consultation beneficially impacted specific clinical and patient safety outcomes. Pharmacist consultations may thus help resolve polypharmacy complexities in primary care.

Healthcare professionals’ involvement in breaking bad news to newly diagnosed patients with motor neurodegenerative conditions: a qualitative study

Purpose Research on breaking bad news (BBN) in healthcare has mostly focused on the doctor-patient interaction during a single consultation. However, it has been increasingly recognised that BBN is a wider process that also involves other healthcare professionals. This qualitative study explored non-medical1 healthcare professionals’ involvement in BBN to newly diagnosed patients with motor neurodegenerative conditions in the UK. Materials and methods 19 healthcare professionals working with people with motor neurone disease, multiple sclerosis, Parkinson’s disease or Huntington’s disease took part in individual, semi-structured interviews which were analysed using thematic analysis. Results Four themes were constructed: dealing with the diagnostic aftermath, unpacking the diagnosis, breaking bad news as a balancing act and empowering patients to regain control over their health and lives. Participants reported being broadly involved in BBN by supporting patients with negative diagnostic experiences, re-iterating diagnostic information and helping patients understand the impact of their condition. The challenges of effectively breaking bad news and how these difficult conversations could help empower patients were also emphasised. Conclusions BBN was a critical and challenging aspect of healthcare professionals’ clinical work with newly diagnosed patients with motor neurodegenerative conditions. Besides providing information, BBN was perceived as a way to educate patients, encourage them to make decisions and prepare for the future. Implications for rehabilitation Breaking bad news is a potentially under-recognised but significant aspect in the neurorehabilitation of neurodegenerative conditions. Listening to patients’ stories about a long and occasionally unsatisfactory diagnostic journey and allowing them to express their frustration can be critical in regaining patients’ trust and building a relationship with them. Newly diagnosed patients have not always received adequate information about their condition at diagnosis or they might have not understood or retained that information. It is, therefore, essential that patients’ understanding of their condition is assessed, misconceptions are cleared and appropriate information about the nature and impact of the diagnosis is provided. Irrespective of the length of experience, breaking bad news was perceived as a multi-faceted, challenging, stressful and emotionally demanding task. Formal support and specialised training on breaking the bad news that addresses the incurable, unpredictable and progressive nature of motor neurodegenerative conditions could help professionals with this challenging task.

Childhood Asthma - The Effect of Asthma Specialist Intervention on Asthma Control: A Retrospective Review.

BackgroundChildhood asthma is the most common chronic disease throughout the western world. Improving asthma control is a leading health management goal.PurposeTo evaluate the effect of an intervention by a visit to an asthma specialist on asthma control in children.Materials and MethodsThis retrospective study was conducted using the electronic database of Maccabi Health Services. All members ages 5–16 with an asthma diagnosis during 2000–2016, and at least one visit to a specialist were included. Asthma outcomes during the 2 years before and after the visit to the asthma specialist were compared.ResultsA total of 37,066 children were diagnosed with asthma. Among them, 13,533 (36.5%) had at least one visit to an asthma specialist and were included. Children with asthma visited their primary care physician more often in the period before the specialist visit (4.4± 4.4 vs 3.16± 3.9 visits, respectively; p<0.01). After visiting a specialist, average number of visits to emergency departments (0.52± 1.3 vs 0.45±1), all cause hospitalizations (0.13±0.45 vs 0.08±0.4) and hospitalizations due to asthma exacerbations (0.08±0.345 vs 0.05±0.3) decreased (p<0.01 for all comparisons). Prescription of short-acting beta agonists decreased (2.85±3.6 vs 2.2 ±3.7, p<0.01) and inhaled steroid prescriptions increased (1.9±2.9 vs 2.7±3.7, p<0.01), respectively, after the intervention. A substantial reduction in the prescription of corticosteroids (0.81±1.9 vs 0.43±1.4, p<0.01) after specialist visit was also noted.ConclusionWe found significant positive outcomes after a single consultation with an asthma specialist. Referring pediatric asthma patients to an asthma specialist should be one of the goals of an asthma management plan.

Analysis of telephone demand in a heart failure unit: something more than a simple call

Abstract Introduction Specific care programs for HF patients significantly reduce readmissions, which is why they are recommended in clinical practice guidelines with the highest level of evidence. Telephone assistance is a service offered to patients within these programs. Purpose The main objective was to evaluate the most frequent reasons for consultation and the ability to resolve them after the call. Methods This is a descriptive, retrospective study of all the telephone consultations registered between June 2020 and January 2021. The calls are attended by the HF consultation nurse, commenting with Cardiology on those that imply changes in the pharmacological treatment. Sociodemographic and clinical variables, reasons for the call and their frequency were collected. Categorical variables were expressed as percentages and quantitative variables as means ± standard deviation. Results During the analyzed period, 1.608 consultations were attended, 494 were telephone calls, which represents 31% of the overall activity of the nursing consultation. 423 consultations were analyzed, 55.7% (235) reactive, and 44.3% (187) proactive. 72.5% of the patients were under follow-up by the nurse, compared to 27.5% who had completed drug titration. The mean age was 65 (± 12.3) years, 65.6% were men, 98.4% had a caregiver, 77% of the patients had an LVEF &amp;lt;40%, Charlson modified mean 4.7 (± 3.6) and 92.3% were on treatment with beta-blockers, 89.1% with ACE inhibitors/ARBs/ARNI and 82.3% with MRA. The mean number of drugs per patient was 8.6 (± 3). Reasons for the reactive calls were in 46% of the cases the consultation of symptoms, 20% to consult doubts about the treatment or procedures, 16% for problems related to the prescription of pharmacological treatment and 14% for the appointment management. Reasons for proactive calls were 40% for symptoms control, 30.5% for appointment management, 27.3% for drug titration and 2.1% related to other causes. When the reason for consultation was the appearance of symptoms, the mean number of calls required was 1.4 (± 0.8), 77.6% of the calls were solved through the telephone, 16.4% required a face-to-face visit in the nursing consultation and 2.7% were referred to the emergency room. Queries related to doubts, problems with the prescription or appointment management were solved in a single telephone consultation. Conclusions The most common telephone request when the patient made the call was the worsening of HF symptoms. The telephone consultation is presented as an effective tool in these cases, by favoring the accessibility of patients and avoiding unnecessary trips to the health center. Funding Acknowledgement Type of funding sources: None. Table 1. Descriptive details of patientsTable 2. Call reasons

Diagnostic accuracy of point of care faecal immunochemical testing using a portable high-speed quantitative analyser for diagnosis in 2-week wait patients.

Laboratory-based faecal immunochemical testing (FIT) is the gold standard for detecting the presence of blood in the stool. The aim was to perform a diagnostic accuracy study to confirm if a point of care (POC) analyser for FIT could be safely used as an adjunct in the triage and management of 2-week wait (TWW) colorectal patients. The Point of Care Faecal Immunochemical Testing (POC FIT) prospective observational cohort study was designed for TWW patients at a regional referral centre. Between July 2019 and March 2020, patients were invited to perform and bring a FIT sample to clinic. FIT was completed within the clinic appointment using a POC quantitative analyser that has a 2-min processing time (QuikRead go®). Patients and clinicians were blinded to results within the clinic appointment. The results were compared with subsequent diagnostic outcomes. Faecal haemoglobin of <10µg haemoglobin/g of faeces was considered a negative result. Sensitivities for colorectal cancer (CRC) and combined serious bowel disease (SBD) were calculated using this pre-determined cut-off. A total of 553 patients were included for analytical comparison with diagnostic outcomes. There were 14 (2.5%) patients with CRC and 52 (9.4%) with SBD. The sensitivities for CRC and SBD were 92.9% (95% CI 68.5%-98.7%) and 76.9% (95% CI 63.9%-86.3%) respectively. 379 (68.5%) patients had a negative FIT result (negative predictive value for CRC was 99.7%). This POC FIT device is a useful adjunct to better manage TWW patients. The high observed sensitivity for CRC offers opportunities, within a single consultation, for improved triage and rationalization of investigation for those with bowel symptoms.

Factors affecting the documentation of spoken safety-netting advice in routine GP consultations: a cross-sectional study.

BackgroundPrevious studies have reported how often safety-netting is documented in medical records, but it is not known how this compares with what is verbalised and what factors might influence the consistency of documentation.AimTo compare spoken and documented safety-netting advice and to explore factors associated with documentation.Design and settingA cross-sectional study, using an existing GP consultations archive.MethodObservational coding involving classifying and quantifying medical record entries and comparison with spoken safety-netting advice in 295 video-/audio-recorded consultations. Associations were tested using logistic regression.ResultsTwo-thirds of consultations (192/295) contained spoken safety-netting advice that applied to less than half of the problems assessed (242/516). Only one-third of consultations (94/295) had documented safety-netting advice, which covered 20.3% of problems (105/516). The practice of GPs varied widely, from those that did not document their safety-netting advice to those that nearly always did so (86.7%). GPs were more likely to document their safety-netting advice for new problems (P = 0.030), when only a single problem was discussed in a consultation (P = 0.040), and when they gave specific rather than generic safety-netting advice (P = 0.007). In consultations where multiple problems were assessed (n = 139), the frequency of spoken and documented safety-netting advice decreased the later a problem was assessed.ConclusionGPs frequently do not document the safety-netting advice they have given to patients, which may have medicolegal implications in the event of an untoward incident. GPs should consider how safely they can assess and document more than one problem in a single consultation and this risk should be shared with patients to help manage expectations.

Implementation of a Machine-Learning Algorithm in the Electronic Health Record for Targeted Screening for Familial Hypercholesterolemia: A Quality Improvement Study.

Implementation of a Machine-Learning Algorithm in the Electronic Health Record for Targeted Screening for Familial Hypercholesterolemia: A Quality Improvement Study.

A Well-Structured Follow-Up Program is Required after Recovery from Coronavirus Disease 2019 (COVID-19); Release from Quarantine is Not the End of Treatment.

During the Coronavirus Infection Disease-19 (COVID-19) pandemic, the number of patients released from quarantine is exceeding the number of newly diagnosed cases. This study is a retrospective cohort study in which consultation data were collected from a COVID-19 follow-up health consultation program. The studied population was selected from patients who recovered after quarantine and treatment for COVID-19 in Daegu City and in Gyeongsangbukdo province, Korea, from March to June 2020. The healthcare providers comprised 20 family-medicine specialists who consulted and educated the patients through phone calls in accordance with structured guidelines. Physical and mental status before and after recovery were compared among patients who received a single consultation and those who received two or more consultations. A total of 1604 subjects were selected for the final analysis. Of these, 1145 (71.4%) had one consultation and 459 (28.6%) had two or more. The group that had two or more consultations reported significantly more physical symptoms, more psychological symptoms (including depression), and more psychological stress. Multivariate forward selection logistic regression analysis showed that re-confirmed cases of COVID-19, physical symptoms after quarantine, feelings of depression, and psychological stress had a significant effect on the number of consultations received. In conclusion, COVID-19 has various physical and mental sequelae after discharge from quarantine. Therefore, a well-structured follow-up program is needed after recovery.

'Reassurance and healthcare seeking in people with persistent musculoskeletal low back pain consulting orthopaedic spine practitioners: A prospective cohort study'.

Guidelines recommend self-management for most people living with persistent musculoskeletal low back pain (PMLBP) when surgery is ruled out. Conveying this message to patients can be challenging. This study examined patients' perceptions of reassuring communications from surgical spine team practitioners attempting to deliver this message in a single consultation. Pre-consultation baseline measures included levels of pain, disability and previous consultation history. Patients' perceptions of reassuring communications were measured within 1-week post-consultation. The outcome variables, measured at 3-month follow-up, included patients' report of subsequent GP visits for back pain, the number of other healthcare providers consulted for back pain and distress. Data from 296 patients (9.8% loss to follow-up) were analysed using hierarchical regression models, controlling for demographic, clinical and study-related factors. In each model, perceived reassurance accounted for a small but significant variance, above and beyond other predictors. Further GP visits were predicted by disability at baseline and perceived reassurance (adjusted R2 of 14.6%). Subsequent consultations with any healthcare professionals were predicted by a shorter duration of back pain, disability at baseline and perceived reassurance (adj. R2 =10.6%). Distress was predicted by older age, disability and reassurance (adj. R2 =59.5%). Findings suggest that better communication in consultations with orthopaedic spine clinicians might help reduce unnecessary subsequent healthcare utilization and distress. Low back pain patients' perceptions of their communication with orthopaedic spine practitioners are associated with subsequent healthcare seeking and distress at follow-up. This study examines the intersection of two important but fairly neglected areas in the pain research: provider communication and patient healthcare utilization.

A Review of Recent Distributed Optical Fiber Sensors Applications for Civil Engineering Structural Health Monitoring.

The present work is a comprehensive collection of recently published research articles on Structural Health Monitoring (SHM) campaigns performed by means of Distributed Optical Fiber Sensors (DOFS). The latter are cutting-edge strain, temperature and vibration monitoring tools with a large potential pool, namely their minimal intrusiveness, accuracy, ease of deployment and more. Its most state-of-the-art feature, though, is the ability to perform measurements with very small spatial resolutions (as small as 0.63 mm). This review article intends to introduce, inform and advise the readers on various DOFS deployment methodologies for the assessment of the residual ability of a structure to continue serving its intended purpose. By collecting in a single place these recent efforts, advancements and findings, the authors intend to contribute to the goal of collective growth towards an efficient SHM. The current work is structured in a manner that allows for the single consultation of any specific DOFS application field, i.e., laboratory experimentation, the built environment (bridges, buildings, roads, etc.), geotechnical constructions, tunnels, pipelines and wind turbines. Beforehand, a brief section was constructed around the recent progress on the study of the strain transfer mechanisms occurring in the multi-layered sensing system inherent to any DOFS deployment (different kinds of fiber claddings, coatings and bonding adhesives). Finally, a section is also dedicated to ideas and concepts for those novel DOFS applications which may very well represent the future of SHM.

Real-World Study on Patient Satisfaction and Tolerability After Switching to Preservative-Free Latanoprost.

PurposePatient satisfaction is important in the treatment of glaucoma. Suboptimal compliance and impaired long-term outcome are a likely result of poor tolerability. The present multicentre, international, transverse, epidemiological survey was conducted to assess the satisfaction of patients who had received preservative-free latanoprost (PFL) for at least 3 months.Patients and MethodsA total of 1872 patients from 6 European countries, treated with PFL for at least 3 months, were included in this survey. Prior to PFL treatment, patients were to be treatment naïve or currently treated for their glaucoma. During a single routine consultation, patients completed a questionnaire concerning global satisfaction and satisfaction based on tolerability.ResultsIn total, 76.2% had been previously treated; 69.4% had received preserved and 6.8% preservative-free (PF) topical treatment. After 3 months of PFL treatment, a large majority of patients (95.3%) were satisfied or very satisfied with their PFL treatment and were, overall, significantly (p<0.0001) more satisfied with PFL than with their previous treatment; 4.2% were either unsatisfied or very unsatisfied. Overall, 97.3% of originally treatment-naïve patients were satisfied (50.1%) or very satisfied (47.2%) with their PFL. Ocular surface disease was diagnosed in 9.2% of patients (n=173) and was mainly mild (76.9%). Patient satisfaction with PFL was very high. ConclusionPFL may be considered a valuable first-choice treatment in glaucoma patients.

279 Effects of diet counseling on gestational weight gain: a retrospective chart review

To determine if dietary intervention in the form of a single 45-minute nutrition consultation is effective in reducing gestational weight gain and its associated complications. A retrospective chart review was performed including all obese patients who received prenatal care and delivered at Stony Brook University Hospital between January 2016 and December 2017. The primary outcome was gestational weight gain. Secondary outcomes included those associated with excessive gestational weight gain. Data was analyzed using SPSS. A total of 624 cases were included. Of those, 208 (33.3%) were referred for nutrition consultation and 142 (22.8%) completed a consultation. Women who completed a formal nutrition consult gained less weight than those who did not (8.8 versus 10.3 kg, p = 0.027), and women who were referred for but did not complete nutritional counseling gained less weight than those who were not referred (8.9 versus 10.5 kg, p = 0.008). Nutrition consultation did not significantly affect mode of delivery, perineal laceration, incidence of fetal demise, neonatal hyperbilirubinemia, or shoulder dystocia. Pregnancy offers a unique opportunity to address obesity in otherwise healthy women. Nutritional counseling is an effective method for decreasing gestational weight gain in obese patients. Population outcomes may be improved with consistent referrals for all obese women upon establishment of prenatal care. This study highlights the importance of timely nutrition consultation for obese pregnant patients.

A study on economic evaluation of an outreach health-care facility in Jhajjar District of Haryana: Service delivery model for increasing access to health care.

An outreach (OR) health-care facility providing broad specialty outpatient services was started by All India Institute of Medical Sciences (AIIMS), New Delhi, in rural area of district Jhajjar, Haryana. This study aimed to ascertain the resource requirement for establishing an OR health-care facility and patient satisfaction with regard to the services being provided. A cross-sectional study was conducted in 2017 at an OR Outpatient Department (OPD) of AIIMS, New Delhi, at Jhajjar. Service delivery model adopted for health-care delivery was hub and spoke. Traditional method of costing was used for economic evaluation. Feedback pro forma of 400 patients who attended OPD services was analyzed to measure health service accessibility. Capital expenditure to set up the facility was calculated to be approximately INR 17,57,49,074/- ($ 2,703,832) and operational cost per year was approximately INR 8,73,86,370/- ($ 1,344,406). Approximate per-patient cost for single OPD consultation was calculated to be INR 874 ($13.45) which included medicines and investigations. High scores for all domains of accessibility of health care were observed. The study provides a preliminary evidence that OR health-care facilities can be instrumental in increasing access to health-care delivery with lesser capital outlays, however, large-scale multicentric studies are needed to arrive at any conclusion. The services have been very well accepted by the local community members being quality medical care with highly subsidized health-care services.

Secondary correction of infertility and oncophobia by means of psychological intervention (clinical case description)

The analysis of psychological correction for post-traumatic stress disorder and progressive chronic psychological stress was carried out. Strategy of the first consultation was based on the principle of A.A. Ukhtomsky, the theory of functional systems by P.K. Anokhin, A. Maslows pyramid of needs, taking into account the hierarchy of emotional stress and cognitive function in the structure of PS, social immobilization and the characteristics of the energy supply of the central nervous system. An algorithm for psychological counseling was developed: 1. Provocation to ensure an intense emotional reaction of suppressed aggression to a stimulus (NLP) under the control of the psychological and physiological state (NLP calibration, lie verification and profiling). 2. Inhibition of the activity of the limbic system and zeroing of emotional stress with the use of pattern interrupt (short-term confusion), followed by breathing control under conditions of transient hypoxia and overload of the representative systems. 3. Conducting resource-relaxation trance (Ericksonian hypnosis). 4. Post-hypnotic suggestion, cognitive analysis and embedding of new patterns of behavior and response to stress. 5. Teaching the method of zeroing emotional stress and reaction to external stimuli. Within 3 weeks after a single consultation, emotional stress disappeared, relations in the professional sphere normalized (transferred to a more prestigious job with a slight increase in salary), friendly relations with a neighbor-friend were restored, and mutual understanding was reached with parents. At the same time, against the background of regression of uterine hypertonicity, the painful formation in the pelvic cavity, perceived as an oncological pathology, disappeared, and the woman got pregnant.

Prolonged therapy of dementia with Lewy bodies with quaternary ammonium anti‐muscarinic/high‐dose cholinesterase inhibitor (QAAM/HDCI)

AbstractBackgroundDementia with Lewy Bodies (DLB) is the second most common human neurodegenerative disease and the most reduction in CNS choline acetyl‐transferase. This case series demonstrates beneficial effects from a level inhibition of cholinesterase inhibition that can only be achieved with concurrent peripheral muscarinic blockade.MethodPatients were selected from those seen in a single geriatric consultation clinic after 2010. DLB was diagnosed by the Consensus criteria of the third report (2005) or fourth (2017) of the DLB consortium by a geriatrician, with concurring neurologist in most cases. Patients received rivastigmine at doses greater that the upper limit of FDA approved dosing. Does greater than 12 mg oral, or 13.3 mg transdermal were paired with glycopyrrolate 1‐4 mg orally twice daily. Concurrent use of carbidopa/levodopa, selegiline was permitted but use of dopamine receptor agonists other than low dose quetiapine, other acetyl‐cholinesterase inhibitors or centrally acting anti‐muscarinic agents was not. Criteria for selection included treatment more than one year, the ability to perform a Mini Mental State Examination (MMSE) at the time of initiation and the availability of follow up data. The MMSE was performed in a standardized format. Functional Assessment Stage (FAST) was determined by nurse and physician after an interview with patient and caregivers.ResultMMSE values over time were compared to recently published rates of decline of DLB. All patients had MMSE and functional improvement, with most having a reduction in the rate of decline of MMSE scores.ConclusionThe results show that prolonged symptomatic, cognitive and functional improvement of dementia with Lewy Bodies is possible with the high‐level inhibition of central nervous system cholinesterase achievable when rivastigmine is combined with glycopyrrolate. The discussion correlates these observations with current experimental, clinical and epidemiological evidence regarding the mechanism and treatment of this, and other, neurodegenerative diseases.

Conceptual understanding and applicability of shared decision-making in psychiatric care: An integrative review.

INTRODUCTION: Patient involvement in decisions regarding treatment has increasingly been supported in health care, and therefore, shared decision-making (SDM), as an informative and participative approach, is promoted in the scientific literature. To review the current state of research regarding the conceptual understanding and implementation of SDM in psychiatric clinical practice. An integrative review that included empirical, theoretical and conceptual research published between 1997 and 2019 was conducted. For this, five health-related databases were searched. Fourteen articles were included in the synthesis. No universal conceptual understanding of SDM regarding psychiatric care could be identified, although several articles highlighted the link with other concepts, such as autonomy and patient-centeredness. Furthermore, four additional key themes with relevance for the successful implementation of SDM in clinical practice were determined. SDM refers to a process and is usually not limited to a single consultation. SDM shows the potential to enhance patient-centred and recovery-oriented care. A collaborative approach including multiple health professionals, peer workers and family members is required. The process of SDM should be made visible for all parties involved. Nurses in particular could play a key role by collecting information regarding patient's preferences and by providing support.

'Water dripping on a stone': a feasibility study of a healthy weight management conversation approach in routine general practice consultations.

Primary health care has an important role to play in the management of weight and yet discussions of healthy weight management do not occur optimally, indicating a need for simple tools and training in brief weight counselling. The 'FABS' approach (focusing on four topic areas: Food, Activity, Behaviour and Support) was developed to address this. To explore the feasibility of the 'FABS' approach within routine general practice consultations and its effectiveness in facilitating healthy weight conversations. The FABS approach was run for a trial period in five New Zealand general practices. The approach entailed staff training, the addition to the practice patient management system of a template outlining potential topics for discussion and a patient handout. GPs were asked to use the approach with any adult patient with a body mass index of over 28 kg/m2. A descriptive analysis of anonymized quantitative practice data was conducted, with limited qualitative data from an online clinician questionnaire and interviews with GPs and patients. Over 4 months, the template was opened 862 times by 27 clinicians in 830 patient consultations. All FABS topics were raised at least once. Physical activity was raised most frequently, followed by two food-related topics. There was variation between practices and between GPs. GPs tended to raise more topics within a single consultation than the training recommended. The limited clinician survey results and patient interviews also indicated positive responses to the approach. It is possible to provide an infrastructure for healthy weight conversation approaches within general practice so that patients receive supportive and consistent messages on a regular basis. General practice is an appropriate setting for this due to the ongoing relationships with patients and team-based approach, but there is a need for effective training and education to ensure appropriate and effectively delivery.