Consultancy Work Research Articles

16687 The economic value of dermatology resident consultations: A retrospective multi-institutional evaluation of hospital-based consultation

Medicare funding for graduate medical education has been threatened, despite the important role residents play in academic medical centers. We sought to characterize the total amount and type of consultation work performed by dermatology residents, and compare that with the amount of Medicare funding hospitals receive for training residents. Hospital-based consults provided by Harvard dermatology residents at Brigham and Women’s Hospital and Massachusetts General Hospital from March 1 to May 31, 2018 were reviewed. Procedures were coded according to the Current Procedural Terminology and converted into work relative value units (wRVUs), which were multiplied by the 2018 rate of $35.999. This value was then multiplied by 4 to generate annual estimates. The annual amount was divided by the number of residents on call, and compared with the Medicare Graduate Medical Education funding of $117,000/resident/year. There were 754 encounters on 389 patients from March 1 to May 31, 2018. The total wRVU during the 3-month period was 1094.9 which represented $40,014.29. For the whole year, the extrapolated wRVU was 4379.6 and corresponding value was $160,057.16. The most common payers were private insurance (48.5%), Medicare (33.2%), and Medicaid (13.9%). The overall financial value generated per resident was $80,028.58, which represented 68.4% of the Medicare stipend. This study suggests that hospital consult services led by residents may substantially offset costs associated with resident training. Future prospective studies may provide additional insight into total economic value generated by dermatology residents on call and underscore the importance of continuing to fund robust graduate medical education programs.

Space, Supplies, Solidarity in an Intensive Treatment Unit during the COVID-19 Pandemic. Interview with Efie Galiatsou, ITU Doctor in a London Hospital

Dr Efie Galiatsou is a critical care consultant working in an Intensive Treatment Unit (ITU) in a hospital in north-west London. This interview was conducted on April 12, 2020, near the peak of the COVID-19 pandemic. In the interview, we talk about the spatial re-organization of the hospital during the pandemic; the problem of supply shortages; and questions of solidarity, activism, and multi-disciplinarity in the context of the pandemic. This interview gives an insider view of the immediate responses of healthcare providers to the pandemic.

TOLERANCE AS A CONSEQUENCE OF SPIRITUAL AND RELIGIOUS EDUCATION OF STUDENT YOUTH

It is impossible to ensure the effectiveness of radical reforms in education related to the country's development prospects without taking into account the worldview and values of an individual, his/her creative self-regulation, training, general spiritual culture, implementation of tolerant behavior and high morals of the younger generation. This determines the relevance of the research problem. The purpose of the study is to clarify and analyze the essence and identify the characteristics of tolerance as a result of spiritual and religious education. To achieve this goal, the following research methods are used: analysis of domestic and foreign philosophical, sociological, psychological and pedagogical literature on the problem (to generalize the theoretical foundations and clarify the essence of tolerance as a result of spiritual and religious education of students; analysis, synthesis, abstraction, generalization (to substantiate the organizational and pedagogical conditions of spiritual and religious education of youth). Therefore, religious tolerance is an important moral and ethical values, worldview and psychological quality of the individual, which consists in awareness, perception, understanding and respect of various religious beliefs, in the recognition and practical assertion of the right of everyone to have religious or free-thinking beliefs. Religious tolerance involves the use of tolerant behavior as one that ensures security in interpersonal relationships; awareness of tolerance as an effective practice of interpersonal communication; recognition of the individual's right to their own worldview and awareness of moral and legal responsibility for compliance with the principle of religious tolerance; practical construction of tolerant relations. For formation of tolerant interpersonal relations in educational work trainings, role games, individual conversations and consultations on a subject of national customs, religious rites, family traditions are used.

Email Consultations Between Patients and Doctors in Primary Care: Content Analysis.

BackgroundIncreasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations.ObjectiveThis study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients.MethodsWe conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation.ResultsWe obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation.ConclusionsMost cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.

Value-based Healthcare: Not Going Anywhere-Why Orthopaedic Surgeons Will Continue Using Telehealth in a Post-COVID-19 World.

Value-based Healthcare: Not Going Anywhere-Why Orthopaedic Surgeons Will Continue Using Telehealth in a Post-COVID-19 World.

The Children's Health and Maintenance Program (CHAMP): An innovative community outreach oral health promotion program: A randomized trial.

To describe CHAMP (Children's Oral Health Promotion Program) evaluating the impact of two motivational methods in increasing dental care access. CHAMP is a multi-dimensional oral health promotion programme that recruited and screened underprivileged children/families from community sites in Los Angeles County between 2012 and 2018. A randomized clinical trial (RCT) enrolled children/families into one or more motivational interventions (intra-oral camera and/or social work consultation) designed to impact subsequent scheduling of dental appointments. CHAMP served 24535 families. RCT had 418 families with 68.5% scheduling appointments by second follow-up (P<.001). Excluding children with scheduled appointments by first follow-up, children experiencing both interventions were 4.1 (95% CI 1.5-11.2) times more likely to schedule appointments by second follow-up than were the controls (P=<.01). When experiencing both interventions and had never previously been to the dentist, 68.3% scheduled dental appointments; this was significantly higher than the controls (46.7%) (P=.04). The best predictor for families to have scheduled appointments was a dental visit within the last six months [OR=3.8 (95% CI 2.2-6.6), P<.001]. Outreach health promotion programmes are important and should consider utilizing various motivational techniques to encourage enrolment and treatment at dental homes.

Personal tales of venous thromboembolism in the UK the last 60 years: from no interest to clinical excellence.

Sixty years ago there was little interest in venous thromboembolism (VTE) in global medical circles, and the British were no different in this respect. And yet, from nowhere the clinical field has developed: now prevention and management of VTE accounts for a large part of many consultant haematologists' working life, while some nursing staff and pharmacists spend the majority of their clinical time in this area. Indeed the 'Brits' have developed enormous VTE expertise and arguably lead the world in prevention of 60% of all VTE, which is hospital-associated venous thromboembolism (HAT).

РЕФЛЕКСІЯ ЯК МЕХАНІЗМ ФАХОВОЇ ПІДГОТОВКИ МАЙБУТНЬОГО ВЧИТЕЛЯ

The aim of the article is to study reflection as a mechanism of professional training of future teachers. The psychological nature of reflection as a universal mechanism of self – regulation and self – development of the personality is considered. In the scientific community there are various approaches to understanding pedagogical reflection. It is interpreted as: activity; component of pedagogical abilities of the teacher; mental neoplasm of the student's personality. The reflection of the future specialist, as his inner mental activity, is aimed at self-knowledge and understanding of their own actions and states, interpersonal relationships and communication with others, because self-knowledge is the initial stage of self-improvement. The teacher's ability to reflect is a mechanism for rethinking stereotypes of consciousness, behavior, communication, thinking, awareness of the bases, means, stereotypes of activity, their critical and heuristic rethinking, generating innovations in various aspects of professional activity. The development of reflexive-project skills allows the teacher not only to realize his professional activity, but also to make the transition from the position of «response» to the position of «self-organization». The teacher learns to teach himself to define the limits of his knowledge (ignorance) and independently find the conditions to overcome their own limitations, thereby increasing their professional competence. An experienced teacher's process of reflection is permanent, depending on: individual and personal characteristics; personal maturity; practical experience; professional erudition; level of general culture. The model of development of reflective skills of future teachers includes a set of different methods and tools, as well as various forms of organization of the educational process, such as lectures, seminars and practical classes, trainings, independent and self-educational work, individual and group consultations. Internships are a key component of each course (compulsory and optional). The key to students' professional development is to encourage continuous growth through critical theoretical understanding, practical application and experimental learning, both inside and outside the university. The ability to reflect is an important factor in the readiness of teachers to innovate, the desire for self- improvement, the introduction of educational innovative products in the educational process.

A tale of three seasons: a cultural sport psychology and gender performativity approach to practitioner identity and development in professional football

ABSTRACT The present study explored how the organisational and cultural experiences of a trainee Sport Psychology Consultant (SPC) working in professional football shaped her identity and professional development. Drawing on Cultural Sport Psychology (CSP) and gender performativity as guiding frameworks, we explored the first author’s identity development as a sport psychology practitioner-researcher within one professional football club over a 3-year duration. Traditional ethnographic data collection methods were employed, including, field notes and a reflective journal. Through creative non-fiction vignettes, we show that the traditional masculine discourse in professional football shaped the first author’s sense of self and subsequent behaviours. From the results of this study, we suggest that SPCs identity development is not smooth or linear, rather it can be described as a ‘rocky road to individuation’ defined by a series of culturally specific ‘critical moments’. We strongly believe that contextual intelligence and cultural proficiency are essential for a trainee SPCs survival during early and later career stages of working within elite and professional sport environments.

The Paths to Realizing Reconciliation: Indigenous Consultation in Jasper National Park

Diverse Indigenous nations have traditional territories inside Jasper National Park (JNP), but the park was established without consultation with local Indigenous communities. Parks were marketed as empty landscapes, which celebrated romantic ideas of European colonial expansion. The current representations of Indigenous Peoples in interpretive content still reflect this lack of consultation. This research was guided by Indigenous methodologies. Data was collected through interviews with Jasper Indigenous Forum (JIF) members and the JNP management team. Findings indicate that JIF members want increased representation and greater control over how their histories and cultures are presented. Park management needs to work in close consultation with the JIF if they want to improve Indigenous representations in the park and support processes of reconciliation.

Increase of Consultants’ Work Efficiency Using ICT at the Lithuanian Agricultural Advisory Service

Information and communication technologies (ICT) allow increase of work efficiency of accounting data processing and business management. Traditional understanding of work efficiency most cases deals only with productivity of consultants, who are providing accounting data input, processing and preparation of reports for farmers. Less attention has be paid to changes of functional abilities of software, technical and communication equipment as well as behaviour of staff, providing consulting service. This article include results of theoretical analysis of factors, influencing understanding of consultants work efficiency in face with higher needs and expectations of consumers. For empirical investigation there were used the data received during questioning of consultants working at the Lithuanian Agricultural Advisory Service who are providing processing of farmers’ farms’ accounting data, preparing various reports for tax office and other official institutions, providing analysis of financial situation of the farms and taking recommendations on improvement of farms management. As the results of made research shown changes that have occurred at the Lithuanian Agricultural Advisory Service over the last two decades due to modernisation of data processing software and modern ICT use.

Blinded by the slide show: Ignorance and the commodification of expertise

This article investigates how commodification operates with reference to expertise, rather than material objects. By drawing on the work of German management consultants, it highlights three forms of ignorance that arise as part of commodifying expertise. These are here described as ignorance due to profit, ignorance due to rhetoric and ignorance due to strong assumptions. These forms of ignorance render invisible the wider socio-economic effects of consulting, hide the degree to which corporate representations may not reflect the world they purport to describe, and postulate specific yet highly skewed understandings of freedom regarding human subjects. Taken together, they point out that a distinguishing feature of the commodification of expertise, vis-à-vis that of material objects, is that it provides greater scope for the creation and use of ignorance, as it blurs the boundaries between commodity and context.

Understanding the supportive care needs of early-phase cancer clinical trial (CT) participants.

26 Background: Early phase CTs investigate novel therapeutic approaches for patients with cancer, but little is known about the use of supportive care services among participants in early phase CTs. Methods: We conducted a retrospective chart review of consecutive patients enrolled in Phase 1 CTs from 2017-2019, capturing sociodemographics, clinical data, and use of supportive care services from the electronic health record. We calculated the Royal Marsden Hospital (RMH) prognostic score using data at the time of CT trial enrollment based on patients’ lactate dehydrogenase, albumin, and number of sites of metastasis. The RMH score ranges from 0-3, with scores of 2+ indicating a poor prognosis. We explored differences in patient characteristics, supportive care use, and clinical outcomes based on the RMH prognosis score. Results: Among 426 patients treated on Phase 1 CTs during the study period, the median age was 63.0 years (range 20.5-85.2 years), and most were female (56.1%), white race (85.1%), and had metastatic cancer (97.7%). The most common cancer types were gastrointestinal (22.1%), lung (20.0%), and breast (10.6%) cancer. Under half (31.6%) had an RMH score indicating a poor prognosis. Patients with a poor prognosis score had a worse performance status (ECOG ≥1: 80.2% v 58.3%, p &lt; .001) and more prior treatment (3+ prior lines: 49.5% v 35.0%, p = .001) compared to those without a poor prognosis score. Those with a poor prognosis score were more likely to receive palliative care before or during CT participation (40.5% v 27.1%, p = .011). We observed no significant differences in the rates of nutrition (69.1% v 64.0%), social work (62.2% v 63.8%), or physical therapy (64.5% v 61.7%) consults between those with and without a poor prognosis score. We found that those with an RMH score indicating a poor prognosis had a shorter time on trial (median: 49 vs 87 days, p &lt; .001) and worse survival (median: 139 v 379 days, p &lt; .001). Conclusions: Early phase CT participants represent an advanced cancer population with unique supportive care needs, and we identified a group with a particularly poor prognosis for whom earlier intervention with supportive care services may be needed. Our findings highlight the need to prospectively examine these characteristics along with patient-reported outcomes to better understand the distinct supportive care needs of this population and guide the development of targeted interventions.

Involvement of social work services in patients with advanced cancer in early-phase clinical trials (EP-CTs).

28 Background: Early integration of supportive care in patients with advanced cancer has improved quality of life, symptom burden, and survival. Participants in EP-CTs often are highly pre-treated and the demands of participation can exacerbate financial and psychosocial concerns. Integration of social work services can address a broad scope of concerns including behavioral health, psychosocial needs, physical health, and financial concerns. Little data exists regarding the use of social work services in this patient population. Methods: We conducted a retrospective chart review of consecutive patients enrolled in EP-CTs at the MGH Cancer Center during 2017-2019. Information including sociodemographic data, clinical variables, and the use of social work services were captured from the electronic health record. We reviewed documentation in social work notes to determine reason for referral while participating on trial. Results: Of 426 EP-CT participants, 64% ( n = 272) received social work consultations at any time during their cancer course (consultations occurred a median of 23 months [range 0 – 444] following diagnosis). Compared to those who did not receive consultation, patients receiving consultation were younger (median age 60.5 years vs 65 years, p &lt; .001) and more likely to have children (63% vs 46%, p &lt; .001). More than half (59%, n = 159) of consultations occurred prior to EP-CT enrollment, while 14% (n = 39) were during patients’ time on EP-CT. The most common reasons for referral on trial included adjustment to illness (41%), limited patient resources (23%), and home/family support (15%). A quarter of referrals (27%, n = 74) were initiated after patients left the trial (27%, n = 74). There were no significant differences in demographic or clinical variables between those referred on EP-CT versus before or after EP-CT. For those who received social work consultation while on EP-CT, median time from date on treatment to consultation was 18 days (0 – 182 days) while median time on EP-CT was 55 days (2 – 576 days). Patients received a median of 2 visits (1 – 20) while on EP-CT. Physicians and research nurses were most likely to refer patients (31% vs 26%, respectively) while 10% of patients self-referred to social work. Conclusions: Over half of EP-CT participants received social work consultations during their cancer course. Most patients who received consultation on an EP-CT did so for psychosocial support. Future research should focus on determining how best to integrate social work into the care of EP-CT participants.

Risk of human-to-wildlife transmission of SARS-CoV-2.

It has been a long time since the world has experienced a pandemic with such a rapid devastating impact as the current COVID‐19 pandemic. The causative agent, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is unusual in that it appears capable of infecting many different mammal species. As a significant proportion of people worldwide are infected with SARS‐CoV‐2 and may spread the infection unknowingly before symptoms occur or without any symptoms ever occurring, there is a non‐negligible risk of humans spreading SARS‐CoV‐2 to wildlife, in particular to wild non‐human mammals. Because of SARS‐CoV‐2’s apparent evolutionary origins in bats and reports of humans transmitting the virus to pets and zoo animals, regulations for the prevention of human‐to‐animal transmission have so far focused mostly on these animal groups. We summarise recent studies and reports that show that a wide range of distantly related mammals are likely to be susceptible to SARS‐CoV‐2, and that susceptibility or resistance to the virus is, in general, not predictable, or only predictable to some extent, from phylogenetic proximity to known susceptible or resistant hosts. In the absence of solid evidence on the susceptibility and resistance to SARS‐CoV‐2 for each of the >6500 mammal species, we argue that sanitary precautions should be taken by humans interacting with any other mammal species in the wild. Preventing human‐to‐wildlife SARS‐CoV‐2 transmission is important to protect these animals (some of which are classed as threatened) from disease, but also to avoid establishment of novel SARS‐CoV‐2 reservoirs in wild mammals. The risk of repeated re‐infection of humans from such a wildlife reservoir could severely hamper SARS‐CoV‐2 control efforts. Activities during which direct or indirect interaction with wild mammals may occur include wildlife research, conservation activities, forestry work, pest control, management of feral populations, ecological consultancy work, management of protected areas and natural environments, wildlife tourism and wildlife rehabilitation in animal shelters. During such activities, we recommend sanitary precautions, such as physical distancing, wearing face masks and gloves, and frequent decontamination, which are very similar to regulations currently imposed to prevent transmission among humans. We further recommend active surveillance of domestic and feral animals that could act as SARS‐CoV‐2 intermediate hosts between humans and wild mammals.

Societal issues and policy implications related to the use of cannabinoids, cannabis, and cannabis-based medicines for pain management.

Societal issues and policy implications related to the use of cannabinoids, cannabis, and cannabis-based medicines for pain management.

Reparation of off-balance sheet damage from a constitutional-labor perspective: A critical approach to the valuation limits set by the labor reform

This article aims to research response to the theme consistent problem in the following questions: What is the constitutional perspective of off-balance labor reparation? What are the possible positive and negative aspects of the limitation of values established by the labor reform of 2017 for the determination of compensation for the practice of extra-asset damage resulting from employment relationship? The theme is currently important, given the favorable positions and contrary to the setting of the limits of compensation for moral damage, so that it is intended to contribute to the discussion through a critical research, which proposes to research the theme in its various possibilities. In the end, it will be possible to observe that there are positive and negative points in relation to the limitation of the values of reparation for extra-asset damage, and it is up to the interpreters to take positions more in line with the solution of the concrete cases. We used the method of deductive approach and dogmatic-legal research of bibliographic nature, with the consultation of works, jurisprudence and legislation.

Brian Turnbull Robson, 1939–2020

Brian Turnbull Robson, 1939–2020

Predictors of low back disability in chiropractic and physical therapy settings

BackgroundPredicting ongoing disability for chronic non-specific low back pain (LBP) is important to avoid prolonged disability.ObjectiveDetermine predictors of disability at 6 month follow-up in patients with LBP at medium risk of ongoing disability.MethodsBaseline data was collected from 108 patients with medium-risk chronic non-specific LBP (mean age 50.4 years, SD 13.6) from six private chiropractic and physiotherapy clinics in Australia who took part in a randomised control trial. All patients received a pragmatic course of multimodal physical treatments [e.g., manual therapy (spinal manipulation or mobilization and/or soft tissue massage)] combined with advice, education and exercise. Baseline prognostic variables included sociodemographic, physical and psychological characteristics. Primary outcome was disability (Roland Morris Disability) at 6 month follow-up. Multivariable linear regression analysis was conducted.ResultsVariables remaining in the final multivariable model: lower work ability (β = − 1.05, 95% CI − 1.40 to − 0.70; p < 0.0001) and consultation with a medical specialist for back pain in the preceding 3 months (β = 3.35, 95% CI 1.14 to 5.55; p < 0.003), which significantly predicted higher disability at 6 months (unadjusted R 2 = 0.31). Those with a lower work ability (scale 1 to 10) and who had seen a medical specialist for their back pain were more likely to report greater LBP-related disability at 6 months.ConclusionPatients with chronic LBP presenting to primary care with lower work ability and recent consultation with a medical specialist for LBP are more likely to have a worse prognosis; these are indicators to clinicians that standard conservative care may not adequately manage the patients’ needs.

Financial and Economic Assessment of Tidal Stream Energy—A Case Study

This case study is based on actual project and consultancy work, balancing real life experience with a review and analysis of empirical and theoretical literature. Tidal stream energy (TSE) is still a nascent technology, but with much better predictability than the classical alternatives of sun and wind. Being still more expensive than other renewable technologies, it is important to find locations in order to initiate a learning process to bring down cost to a competitive level as it was the case for solar and wind technologies. Locations for an initial phase of operation of TSE small islands in the Philippines (and other Asian countries) were found to be most suitable, because expensive and polluting diesel generators can be replaced and a reliable 24 h electricity supply can be established. Different appraisal methods in different scenarios show that under normal circumstances a hybrid combination of TSE, solar energy and battery storage is financially and economically superior to existing fossil energy based power stations as well as to solar energy alone. However, the traditional financial approaches are not always reliable, in spite of superficial mathematical exactness, and the parameters used must be analysed carefully, especially if we deal with innovative technologies with fast changes. In times of global warming we must also include the controversial issue of evaluating damages from greenhouse gases if choosing fossil alternatives. When evaluating and planning renewable technologies, engineering know-how is important, but insufficient. Since financing is a crucial issue for most renewable technologies with high front loaded cost and long amortisation periods, a thorough and trustworthy financial and economic analysis is necessary not only to avoid financial failure later on, but also to attract stakeholders like private investors, banks and government institutions to support a still unknown technology.