Consultant Staff Research Articles

Letter from the Editors-in-Chief

This year has generated more growth for our journal. We have moved to a system of continuous publication, allowing papers to be published as they are ready, as opposed to waiting until the end of each term. Authors are able to see the outcome of their work more quickly, and the articles are more immediately accessible to readers. It’s been valuable to explore new approaches to publishing to keep pace with the volume and quality of undergraduate research on campus.The articles in this issue represent a breadth of research across disciplines, methodologies, time periods, and geographies. Each of them brings insightful analysis to original research questions, and offers new perspectives in larger scholarly conversations.Kendra Schreiner compares the leadership styles and legacies of two influential political figures in southeast Asia, to highlight the significance of not only the leaders’ own life histories, but also their subjects’ experiences, when explaining how particular personalities come to power. Evaluating current trends in the field of nursing, Kira Marie Olson argues for better testing of nasogastric tube placement methods in order to improve patient care. Arjun Singh Jabbal and Adam Baxter-Jones address a central question for many athletes: which training method is most effective for building endurance. They call for ongoing attention to the issue. Lauren Tarasoff, Leah Ferguson, and Kent Kowalski seek out ways to foster healthy experiences for competitive dancers by examining the kinds of barriers to self-compassion that dancers themselves may experience. Recognizing pervasive trends in trades professions, Leanne Jaeb, Evan Parker, Courtney Black, and Karissa Cooper examine and measure how sexism can affect workplace safety. Amani Khelifa brings a new analytical lens to accounts about two Indigenous women in the sixteenth and seventeenth centuries, demonstrating the value of reading colonial texts “between the lines” to seek out marginalized voices. Finally, Sarah Wist compares the effectiveness of several types of pesticides for cabbage productivity, with implications not only for home gardeners but also for commercial canola growers and market gardens.As one of many initiatives at the University of Saskatchewan supporting research at the undergraduate level, USURJ offers the opportunity for students and editors to disseminate undergraduate research and enhance the visibility and accessibility of work that might otherwise go unshared. This endeavour would not be possible without the hard work and dedication of student volunteers, reviewers, authors, and faculty and staff advisors, the Office of the VP Research, and the University Library. We extend our sincere gratitude as we celebrate another successful issue of USURJ.Katya MacDonald & Courtney BallantyneGraduate and Undergraduate Editors-in-ChiefJanuary 26, 2017

Designing a grazing-system experiment for variable native pastures and flexible lamb-production systems

Grazing-system experiments address complex interactions among animals, pastures, soils, climate and management. As part of the national EverGraze program, a grazing-system experiment was designed to determine how the intensity of grazing management, from continuous grazing (P01) to flexible 4- and 20-paddock rotational systems (P04 and P20), influences the profitability and sustainability of a Merino ewe, terminal sire, lamb production system grazed on heterogeneous native pastures. When implementing such an experiment, it is important to understand and characterise landscape variability, and include this in the design of the experiment. A second challenge for grazing-system research is to operate experimental systems with sufficient flexibility to adequately represent commercial production systems and maintain even utilisation across treatments. The present paper addresses the following two issues: (1) the process used to characterise the potential productivity of variable native pastures and the results of this characterisation; and (2) the development of flexible systems that adequately represent commercial production within an experiment. This was undertaken with input from a project-steering committee called the EverGraze Regional Group, comprising producers, extension staff and private consultants. Prior to the commencement, the site was mapped into three production zones, namely, high (HPZ), medium (MPZ) and low (LPZ), by visually estimating green herbage mass in late spring and marking boundaries between zones with a GPS. The production zones represented differences in soil properties (gravel, pH and available P) and pasture composition, and were used to balance potential production among plots within the same replication. Grazing-system options were evaluated using the sustainable grazing systems pasture model to help choose an appropriate starting stocking rate. The initial stocking rate chosen for the spring-lambing systems was 5.4 ewes/ha. The modelling predicted large variations in feed availability and quality over summer among years; flexible management criteria were therefore developed, including variable sale time for lambs, to utilise the greater feed supply in better seasons. Minimum-pasture benchmarks (>0.8 t DM/ha standing herbage mass and >80% ground cover) and variable green herbage-mass targets were designed to sustain high levels of livestock production and prevent pasture degradation. Criteria for adjusting ewe numbers were developed, but were constrained to pre-joining (March), scanning (July) and post-weaning (December), being consistent with commercial practices. The experiment incorporated flexible management rules as these were considered integral to the successful management of commercial grazing systems.

P237 Assessing the impact of a HIV testing policy

Background/introduction Mirroring national data, HIV testing in our local board is failing to reduce the high proportion of late diagnoses. Healthcare Improvement Scotland (HIS) HIV standards 2011 recommended the development and promotion of a written HIV testing policy. A local HIV testing policy was introduced in 2013 based on the UK National testing guideline (BHIVA), recommending routine testing in certain clinical areas, in high risk groups and all individuals with “clinical indicator conditions” regardless of perceived risk. The introduction of the policy was supported by staff training. Aim(s)/objectives Review the impact of a HIV testing policy on staff knowledge and levels of HIV testing. Methods In November 2015 a survey was undertaken to question staff awareness of the policy, understanding of HIV testing and levels of HIV testing. The survey was advertised on local websites to healthcare, social work, third sector and substance misuse staff. Results The survey had 120 respondents, with the largest proportion from Consultant and GP staff. Over 70% of respondents were aware of the policy. 25% reported that the policy had changed their clinical practice by increasing their confidence in testing. There has been a corresponding increase in HIV testing figures. Interestingly over 70% responded that a detailed HIV risk assessment was required even in the presence of a clinical indicator condition. Discussion/conclusion The survey has demonstrated that the HIV testing policy has increased staff awareness and confidence in HIV testing. Late diagnosis rates continue to be monitored and misconceptions regarding HIV testing challenged.

PTH-005 Macroscopic Colonoscopy Findings of Collagenous Colitis; A Three-Centre Experience

Introduction Microscopic colitis (MC) encompasses 2 entities, collagenous colitis (CC) and lymphocytic colitis (LC).1 Although (by definition) a histopathological diagnosis, there are occasions when colonoscopy reveals findings such as alteration of the vascular mucosal pattern/innominate grooves, mucosal nodularity and a sequence of mucosal changes from defects/lacerations to cicatricial lesions that are thought to be characteristic of MC, and especially CC.1,2 The aim of this study was to evaluate the frequency and type of endoscopic findings in patients diagnosed with CC in two University Hospitals. Methods Retrospective study. The databases of the Pathology Department of 2 university hospitals in Edinburgh (Scotland) and Malmo (Sweden), and a district general hospital in Spain (Hospital General de Tomelloso) were searched for patients who had been diagnosed with CC between May 2008 and August 2013. Endoscopy reports and endoscopic images were retrieved and reviewed; data on lesions, sedation, bowel preparation (type and effect) and endoscopists’ experience were extracted. Categorical data are reported as mean±SD. The Fischer’s exact, chi-square and unpaired t tests were used to compare datasets. A two-tailed P value of Results The case notes of 416 patients (96 M/320 F; mean age: 67.1±12.1 years), who had been diagnosed with CC, were collected and reviewed. The colonoscopies had been carried out by senior medical/surgical staff (consultants or associate specialists) in 331 (79.6%). A total of 81 (19.5%) patients had a mix of findings previously described as being suggestive of CC in endoscopy, such as mucosal erythema/oedema (mosaic pattern) (n = 65), colonic mucosa linear defects (lacerations, tears, ulcers/fractures, mucosal furrows) (n = 10), cat-scratch mucosa (n = 4), and cicatricial lesions (n = 3). Although the use of polyethylene glycol (PEG) offers superior quality of bowel preparation effect (as compared to other pre-colonoscopy preparations; P Conclusion A substantial minority of patients with CC (19.5%) had endoscopic findings indicative of CC. The presence of these findings is not associated with procedural factors such as endoscopist’s experience, quality of bowel preparation, and/or use of spasmolytic during colonoscopy. References 1 Koulaouzidis A and Saeed AA. Distinct colonoscopy findings of microscopic colitis: not so microscopic after all? World J Gastroenterol. 2011;17:4157–4165 2 Suzuki, et al. Usefulness of colonoscopic examination with indigo carmine in diagnosing microscopic colitis. Endoscopy. 2011;43:1100–1104 Disclosure of Interest A. Koulaouzidis Grant/research support from: Given Imaging ESGE research grant 2011, Conflict with: Lecture fee(s) from: Dr FalkPharmaUK, Other: Travel support: Dr FalkPharma, Abbott, MSD, K. Sjoberg: None Declared, L. Bartzis Grant/research support from: Hellenic Society of Gastroenterology, M. MacNeill: None Declared, A. Nemeth: None Declared, D. Yung: None Declared, G. Johansson: None Declared, P. Fineron: None Declared, A. Lucendo: None Declared, E. Toth: None Declared

Oral anticancer medicines in acute oncology; recognition by non-specialist clinicians and risk reduction measures

ObjectiveThis study investigated the awareness of non-oncology specialist medical staff about commonly used oral anticancer medicines (OAMs).MethodsInterviews conducted with a range of non-oncology specialist doctors.ResultsThe recognition of OAMs was poor...

Implementing Montessori Methods for Dementia™ in Ontario long-term care homes: Recreation staff and multidisciplinary consultants' perceptions of policy and practice issues.

Montessori-based activities use a person-centred approach to benefit persons living with dementia by increasing their participation in, and enjoyment of, daily life. This study investigated recreation staff and multidisciplinary consultants' perceptions of factors that affected implementing Montessori Methods for Dementia™ in long-term care homes in Ontario, Canada. Qualitative data were obtained during semi-structured telephone interviews with 17 participants who worked in these homes. A political economy of aging perspective guided thematic data analysis. Barriers such as insufficient funding and negative attitudes towards activities reinforced a task-oriented biomedical model of care. Various forms of support and understanding helped put Montessori Methods for Dementia™ into practice as a person-centred care program, thus reportedly improving the quality of life of residents living with dementia, staff and family members. These results demonstrate that when Montessori Methods for Dementia™ approaches are learned and understood by staff they can be used as practical interventions for long-term care residents living with dementia.

Ian Bruce Sneddon (1915-1987).

Ian Bruce Sneddon (1915-1987).

Letter from the Editors-in-Chief

An issue of USURJ takes form through case-by-case selection of exceptional student work, without consideration for theme; this is in keeping with the nature of a multidisciplinary journal. It is a pleasant inadvertency that, although issue 2.1 is penned by a diverse academic community, it yields notable thematic cohesion.In fact, cohesion is itself variously focused upon by issue 2.1, through its authors' research into issues of personal and societal well being. One researcher supports the incorporation of culturally meaningful healing processes into mainstream medical care. Another highlights the importance of the patientdoctor relationship and long-term, consistent health care, by proposing a tool for improving continuityof-care during medical professionals' residency training. We learn about the potential of combining GIS mapping, soil test data, and socioeconomic survey results to boost West African smallholder farmers' profitability and community well-being, by enabling efficient enrichment of nutrient-deficient soil. Finally, the politically and socially unifying power of music with a cause is demonstrated, through punk band D.O.A.'s part British Columbia's labour movement in the 1980s.We hope you will be as delighted as we are by the work of our featured visual artist, Stephanie Mah, as she explores breaks and connections between human and nature, and delicately twists them into powerful moments for us to experience.The knowledge and ideas shared in issue 2.1 certainly demonstrate the relevance and power of publicly engaged undergraduate research. Similarly, as the collaborative product of student editors, researchers, faculty, and reviewers, USURJ represents our desire to improve, to disseminate knowledge, and to contribute meaningfully to a larger community of research.Thanks to the diligence and initiative of our contributors, USURJ has established itself as part of the University of Saskatchewan academic community. Consequently, both volunteers and research submissions are increasing in number and, for the first time, we are now able to release two issues in one academic year.We have many contributors to thank for building up USURJ, and we do so with genuine appreciation. We hope that our hardworking authors, reviewers, and editors are as proud as we are of their promotion of valuable undergrad research! Thanks are particularly due to Liv Marken (staff advisor) and Kathleen James-Cavan (faculty advisor), who have been with USURJ since its inception, providing stability and expertise to the journal and its volunteers.Happy reading!Nicole Haldoupis, Graduate Editor-in-Chief& Caitilin Terfloth, Undergraduate Editor-in-Chief

The Auditing Standards Committee of the Auditing Section of the American Accounting Association is Pleased to Provide Comments on PCAOB Staff Consultation Paper No. 2015-01,The Auditor's Use of the Work of Specialists

SUMMARYOn May 28, 2015 the Public Company Accounting Oversight Board (hereafter, the Board) issued Staff Consultation Paper No. 2015-01 (hereafter, the Staff Consultation Paper) to seek information and input on the potential need to improve standards related to the auditor's use of the work of specialists. The Board requested input from investors, accounting firms, specialists, companies, and others (such as academics) about (1) current practices, (2) the potential need for changes, and (3) possible alternative regulatory approaches, and any associated economic implications, for potential improvement in standards related to oversight and assessing the objectivity of employed and engaged specialists. The comment period ended July 31, 2015. This commentary summarizes the contributors' views on selected questions posed in the Staff Consultation Paper.Data Availability: The invitation to comment (through July 31, 2015), with links to the Consultation Paper, is available at: http://www.pcaobus.org/Standards/Pages/SCP_Specialists.aspx

Comments of the Auditing Standards Committee of the Auditing Section of the American Accounting Association on PCAOB Staff Consultation Paper,Auditing Accounting Estimates and Fair Value Measurements

SUMMARYRecently, the Public Companies Accounting Oversight Board (PCAOB) solicited public comments on its Staff Consultation Paper Auditing Accounting Estimates and Fair Value Measurements. This commentary summarizes the contributors' views on the various questions asked in the PCAOB Staff Consultation Paper. Our comments submitted to the PCAOB appear below.Data Availability: The invitation to comment (which invited comments through November 4, 2014), with links to the consultation paper, is available at: http://pcaobus.org/Standards/Pages/SCP _ Accounting _ Estimates _ Fair_Value.aspx

London's liaison psychiatry services: survey of service provision.

Aims and method To describe the liaison psychiatry services of all 30 general hospitals in Greater London and to determine whether services met national recommendations. The results were compared with a similar survey conducted 8 years previously to determine whether there had been significant service development.Results We identified wide variations in service provision across London. Fifteen hospitals (50%) had 24-hour services and one had no service. There had been a significant increase in services that assessed older adults. Increases in the size of teams and consultant psychiatry staff were not significant.Clinical implications Despite an increasing emphasis on the effectiveness of liaison psychiatry services, no London hospital had staffing levels consistent with national recommendations. Recent evidence for the cost-effectiveness of liaison psychiatry and an emphasis on parity between physical and mental health in National Health Service policy may provide further impetus for growth.

G539(P) Trainee-led quality improvement in enhancing service in community paediatrics

Context We planned to address two key areas of service provision in our secondary level hospital. Firstly, in keeping with many Community Paediatric Departments, our hospital has experienced an increase in the number and complexity of referrals. As a result many families had long waits for consultations. Secondly in our trust safeguarding work had historically represented a large proportion of the acute workload. Problem and Assessment 1. Child Development Centre (CDC) appointments Long waiting lists for medical appointments were negatively affecting patient care. The department was not compliant with the NICE guidance on the timeframe for assessment of children with possible social communication disorders. Patient satisfaction surveys had also identified this as an area of concern for families. 2. Child Protection Assessments Vulnerable children competed with acute admissions for assessments and were often seen out of hours, when Consultant medical staff were not on site. Social Care had highlighted concerns about long and unpredictable waits for assessments. Intervention Firstly, trainees in consultation with their consultant supervisors developed a flexible clinical arrangement to target service provision and meet community competencies in the CDC setting. Trainees were expected to complete six CDC clinics during their six month rotation, which were tailored to the trainee’s acute rota. Secondly, a daily child protection medical clinic was implemented and delivered by trainees under consultant supervision. Monthly safeguarding peer review meetings were initiated in line with Royal College of Paediatrics and Child Health guidance to provide support and facilitate training in this area. Strategy for change To instigate and review the response to change, the Plan-Do-Study-Act (PDSA) cycle was used. An initial multi-disciplinary team (MDT) meeting was used to formalise plans and disseminate information, with three monthly MDT feedback meetings planned. Measurement of improvement During the initial six month period, review of waiting lists has shown that trainee delivered CDC clinics have resulted in a reduction of waiting lists by 56 patients (the equivalent of 0.4 PA Consultant time). Urgent new patient appointments have fallen from 12 to 0, although routine new patient appointments have increased from 45 to 68. Feedback from the MDT is largely positive. Review of child protection referrals has shown that following the instigation of child protection medical clinics the number of assessments occurring out of hours has fallen to 19% compared to 44% previously. 81% of children are now seen at a prearranged time, without delay, compared to approximately 23% previously. Trainees report feeling more supported in carrying out safeguarding work. A repeat CDC patient satisfaction survey and a planned audit of the child protection clinics will provide further feedback on the success of these interventions, which will lead to further action (PDSA). Effects of changes Developing a flexible approach to encompass trainees’ acute commitments, has required meticulous planning. Room availability was an unexpected factor needing close consideration in the plans. Involvement of trainees has required support and supervision both from Consultants, and the wider MDT, thus requiring some changes to their previous practice. Lessons learnt Managing a change in service provision requires consideration of many different priorities. When trainees take a key role, it ensures the changes work at their level. Message for others Working within the European Working Time Directive and today’s financial constraints, a flexible approach to service provision is necessary. This initiative has highlighted that direct trainee involvement in the design of service delivery can result in significant changes that benefit patients, trusts and trainees alike. Moreover this venture has enhanced community training, as well as providing trainees with valuable experience in management of change.

G562(P) Medical productivity: quality care and quality training

Context Inpatient general paediatrics is provided by a variety of medical staff, including Paediatric trainees, General Practice trainees and Foundation doctors. This project considered how to provide safe patient care and a supported training experience through optimising medical productivity. Problem In light of reconfiguration of paediatric services, there is a need to make efficient use of medical staff as a resource, at the same time as providing quality training. Junior staff noted that time was spent on activities other than patient contact. End of placement and GMC surveys identified that trainees failed to attend the recommended number of study days and clinics due to service demands. This project was undertaken to identify inefficiencies in the working patterns of general paediatric juniors, measure the impact on patient care and training, and highlight opportunities for quality improvement. Assessment of problem and analysis of its causes In an 8 h shift, trainees spent 48 min on average directly interacting with patients and 25 min in teaching. This lack of patient contact time could not only result in poor patient care but could also impact on the skills and knowledge of trainees. This may effect quality of care in the future. A multidisciplinary focus group and anonymous interviews were held to establish staff views about the causes of these problems. These issues could be resolved by implementing non-urgent jobs books on wards and redesigning rotas. Intervention New rotas were designed aiming to prioritise patient contact time, protect training opportunities and match staffing patterns to the clinical needs of the children. Full entitlement of study leave was also allocated. Attention was brought to the topic of interruptions with ward staff, and non-urgent jobs books introduced to maximise medical productivity. Study design Ethnographic data was collected by shadowing 10 trainees over 5 weeks, verbal consent was obtained. Their intended and actual tasks were recorded each minute, as well as the number of times they were interrupted. Over 5000 min of data was collected. Strategy for change Results of the shadowing data were presented at a clinical governance meeting (those who could not attend were provided information by email). New rotas underwent a formal consultation process with trainees, as well as Wales Deanery and the Welsh Assembly Government. The jobs book will be introduced at the same time as new rotas are implemented in March 2015. Measurement of improvement The same method of data collection will be used to collect ethnographics following implementation of changes. Mean time spent on each activity will be compared. Number of interruptions and the extent to which actual versus intended task is affected will be analysed. Time spent training will also be recorded. The improvement cycle can then be repeated. Effects of changes The new rota has been designed but not yet implemented, therefore the effects at the point of abstract submission are not yet known. However it is anticipated that the effects will be more patient contact, less frequent interruptions and greater opportunities for training. These results will be available by April 2015. Lessons learnt Large scale service improvements require careful consideration of human factors and engagement from all stakeholders involved to successfully overcome barriers to change. Message for others Rotas not designed around patients or trainees lead to low levels of patient contact, an inefficient service, and fewer opportunities for training. Consult staff widely and early in a quality improvement process.

Internal Control: Forensic Investigation Certification - Gold Standard in Fraud Detection and Prevention

The Certified Forensic Investigation Professional (CFIP) and Fraud Examiners certification are now the gold standard in fraud detection and prevention. CFIPs, CPFAs/CFEs are known the world over as fraud-fighting experts. The CFIP, CPFA and ACFE have built respected organizations that are at the forefront of forensic investigation, fraud research and education. Robust fraud prevention programs must use CFIPs, CPFAs/CFEs as staff members or consultants. CFIPs, CPFAs/CFEs can also assist the audit committee, internal auditors, and independent auditors in their oversight capacities. CFIPs, CPFAs/CFEs in fraud prevention programs can be deterrents to potential fraud perpetrators.

The Experience of Receiving and Delivering Consultation in a Residential Childcare Setting for Looked-after and Accommodated Children: A Sequential Exploratory Design

Looked-after and accommodated children are at higher risk of poor mental health and behavioural difficulties and experience high levels of emotional and psychological distress. Consultation plays a pivotal role in providing indirect support to vulnerable children and young people. The aim of this study was to explore the experience of consultation in three residential childcare settings. A mixed-methods sequential exploratory design was used. In the initial phase, a questionnaire survey exploring consultees' experience of the consultation process was conducted in three residential care establishments (N = 30). In the second phase, focus groups were conducted with both staff groups and consultants (N = 15). Results from the first phase identified themes around the interpersonal skills of the consultant, the helpfulness and the limitations of consultation. Using a thematic analysis approach in this second phase, three consultee themes emerged: the value of consultation, a new way of working, and the consultation relationship. The three consultant themes identified were: understanding roles, challenges, and building the consultation relationship. Results are discussed with reference to the current literature. These findings may impact on service development and clinical practice to improve the quality of care for looked-after and accommodated children.

Forensic Psychiatric Outpatient Consultation Service at the Psychiatric Department of Saint John Hospital, Budapest Between 2007-2014

Our forensic psychiatric outpatient consultation service for the Main Detention Centre of Budapest (MDC) started in 2007 May. Before our consultations the clients are examined by the medical doctor of the MDC, and his/her decision to ask for psychiatric examination with specific questions. The clients are transferred by the police to the hospital. We analysed retrospectively all the cases of 7 years. Objectives statistical and qualitative analysis of clients’ reports of 529. The clients were before judicial process and detained in custody in the MDC. Aims to analyse the frequent problems and the clinical questions by the referral doctors, the necessity of these problems, and the severity of the clients symptoms. Methods We analysed all the files, and the objectives: referral diagnosis, diagnosis after our examination, suicide intentions, intentional aggravation, heteroagression, psychiatric history, drug use and dependency, current medication, presence of psychotic symptoms. Results Between 2007-2014 September there were 529 examinations. The most frequent question was to evaluate the suicide risk and to measure the necessity of the admission to an acute psychiatric unit. The number of the referrals remains 80-90 per year since 2012, 33% of the examined clients were diagnosed with personality disorder at our unit. Conclusion Specialised service is needed (Forensic Psychiatric Unit) to evaluate more precisely the severity of suicide risk, and to exclude the intentional behaviour. Consultation and training of the MDC medical staff can enhance the more precise psychiatric evaluation especially to differentiate between personality and major psychiatric disorders.

The patient perspective of the diagnostic process for leprosy in Brazil. An exploratory study

To explore the patient experience of being diagnosed with leprosy and the support provided during this process in selected populations in Brazil. To understand the information needs of patients during diagnosis. To identify characteristics of patients with different diagnostic experiences. To add to the evidence base used for improving the diagnostic process for leprosy patients. A self-constructed questionnaire delivered to 116 participants, at three leprosy health centres, across three states in Brazil. Most participants felt under-informed during diagnosis; 68.1% wanted more information about leprosy. Nearly one-quarter of patients reported feeling unable to ask questions at diagnosis. Almost half of patients reported being worried about treatment, yet 43.3% reported not having the chance to talk about their concerns. Younger participants were significantly more likely to report feeling unable to ask questions and talk about their worries. The majority of participants (59.5%) reported not being given any written information to take away with them. 36.5% reported not being given advice about how to reduce the chance of other family members becoming ill with leprosy. Older males were most likely to be given this advice despite females being in most contact with family members in most cultures. It is recommended that patients are encouraged to ask questions and invited to talk about their concerns, particularly younger patients. It is recommended that a simple information leaflet be provided to all patients. These suggestions may require some financial input, more staff and longer consultations but should significantly improve the diagnostic process.

Un circuit court pour désengorger les services d’accueil des urgences pédiatriques

The number of emergency pediatric consultations continues to rise in France. The pediatric emergency department (PED) introduced relocated consultations (RlCs) for unwarranted visits to relieve the overload of emergency medical consultations. The objective of this study was to assess the advantages of implementing these RlCs. A single-center prospective study was undertaken from 21st January to 18 March 2012, with RlCs opened on weekends from 1 to 8 pm in the PED of the Nice Lenval University Hospital Center. All children referred for medical reasons during this period were included. One out of two children labeled stage 5 were transferred to the RlCs. The data evaluated were waiting time, duration of the medical consultation, transit time, and patient and medical staff satisfaction. Eight hundred and seventy-five patients were included. All patients in stages 1-2, 3, 4, and 5, relocated or not, had a mean waiting time before the medical consultation lasting 39.1, 57.7, 54.8, 70.5, and 52.7 min, respectively. The mean duration of the medical consultation was longer for stages 1-2 (61.6 min). The total time spent in the PED did not differ between stage 5 patients who were not relocated (121.3 min) and stages 1-2 (118 min), but both were longer than stage 5 patients who were relocated (90.3 min). Patients and medical staff expressed overall satisfaction during this period. By relocating one out of two stage 5 children, waiting times and consultation times decreased for all patients consulting at the PED. These results confirm that implementing RlCs has improved working conditions and quality of patient management.

Group Counseling with South Asian Immigrant High School Girls: Reflections and Commentary of a Group Facilitator

The diversity of the U.S. school population speaks to a need to provide support for youth from various backgrounds. As a school-based mental health counselor, the first author observed that the South Asian immigrant students at her school did not utilize any of the counseling services provided. Because South Asians are typically collectivistic, the counselor chose group counseling as a potential intervention and hoped to provide a place for the students to address issues related to orienting to a new school in a new country. In this article, the authors weave information about the South Asian population into the first author's reflections and commentary on initiating and conducting a group with South Asian high school girls. Recommendations for group counseling in schools with South Asian immigrants are provided.Keywords: South Asian, immigrant, youth, schools, group counselingThe United States has seen a marked increase in the number of children who have at least one parent bom outside the United States (Capps et al., 2005). Between 1995 and 2012, the population of first- and secondgeneration immigrant children in the United States increased by 66% (Child Trends Data Bank, 2013). This sharp rise is important for American cities because 95% of all children of immigrants attend urban schools (Fix & Capps, 2005). Furthermore, according to a recent update from the Asian American Federation and South Asian Americans Leading Together (2012), the South Asian American population was the fastest growing major ethnic group in the United States from 2000-2010. Relationship building is part of acclimatizing to a new country for immigrant youth, and it is in the schools that these youth build new friendships and create social networks (Suarez-Orozco, Suarez-Orozco, & Todorova, 2008). For South Asian youth in American schools, group counseling can provide a setting for students to connect to others who share similar stories and experiences. Groups can offer a safe place for them to discuss their cultural norms, exchange stories of challenges and hope, and enhance their social development in a new country as they form emerging adult identities.As a school-based mental health counselor in a public urban high school on the northern California coast, the first author's responsibility is to provide overall behavioral health support through assessments, counseling (short- and long-term, individual, group, crisis), staff and teacher consultations, and presentations on mental health issues to students, parents and teachers. When two South Asian students were referred for individual counseling, the first author wondered if other South Asian students might be experiencing challenges associated with adjusting to a new school in a new country. She also was personally aware of difficulties associated with identity development for adolescents negotiating different home and school cultures. She decided that counseling focused on prevention of problems related to acculturation and identity could be helpful to the South Asian students in her school. Because the South Asian collectivistic orientation is consistent with the goals of group counseling (Sharma, 2001), she chose this approach. As a South Asian herself, the first author believed that her understanding of South Asian culture could contribute to her effectiveness as facilitator of a group with this population. Thus, the first author developed a simple strategy for recruitment and set out to create a group for South Asian immigrant high school students.Although in many cases the first author's expectations about the group were met, she also confronted surprises and challenges. This article is the result of discussions with the second author in which the first author shared her reflections and commentary on the facilitation of students' exploration of issues in the group. The goal is to impart the first author's personal knowledge and perceptions, so that counselors working with South Asian youth may consider how her experience might inform their group work with this population. …

Professional background and working practices of consultants in school development: Initial empirical findings from Germany

In Germany, it can be observed that schools increasingly take advantage of experts from the outside in their further pedagogical and organizational development. Regarding their profession and the area of content to which they are assigned, these experts represent a heterogeneous group. This contribution assumes that several patterns can be observed that have to do with the professional background of the consultants as well as with the content and the way these consultants work. It takes up insights from a larger research project conducted in the German state of North Rhine-Westphalia from 2009 to 2012. The project’s findings were gained by means of a standardized survey of 957 school administrations and case studies at six schools with standardized interviews of teachers (20–87 per school), qualitative interviews with school administrations and teachers (5–8 per school), as well as document analyses on the design, the process and results of the external consultation of schools. The results indicate that there are two different types of consultation: the consultation of the entire teaching staff in the area of teaching development with a consultant who is directly connected to the school system (type 1), and a consultation of subgroups of the teaching staff in the area of organizational and personnel development with a consultant from outside the school system (type 2). This contribution provides new insights into a field that has in the German speaking context so far not been well researched.