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Objective: The aim of this study is to evaluate the clinical, demographic, and diagnostic characteristics of pediatric patients consulting the dermatology department. Methods: Patients who were consulted to the dermatology department from pediatric clinic of XX Hospital between January 2021 and August 2021 were scanned retrospectively. The demographic data of the patients, the pediatric department requesting consultation, their complaints at admission, the reasons for asking for consultation, and the diagnoses they received as a result of the consultation were recorded. Results: A total of 296 patients, 150 (50.7%) females and 146 (49.3%) males, with a median age of 5.5 years (1.5-10.5 ) were evaluated. The outpatient clinic were seen to have made the most requests for consultation. The most frequent complaints on presentation were seen to be redness of the skin in 168 (56.8%) cases and itching in 36 (12.2%). The five most common diagnoses made as a result of the consultation were unspecified dermatitis in 47 (15.9%) cases, scabies in 34 (11.5%), insect bite in 17 (5.7%), atopic dermatitis in 13 (4.4%), and seborrheic dermatitis in 13 (4.4%). When the diagnoses were examined according to the age groups, unspecified dermatitis was usually seen in the 0-2, 6-11, and 12-18 years age groups and insect bite was more common in the 3-5 years age group. Conclusion: The establishment of effectively functioning consultation mechanisms not only facilitates a correct diagnosis for the patient and appropriate treatment, but also can shorten the length of hospital stay for pediatric patients and can reduce economic costs.

Abstract Objectives Changes in periodontal referral patterns over time have been reported from the United States and Australia. To date, comparable studies have not been published from Europe. The objectives of the present study were to examine changes in periodontal referral patterns in Norway in 2003 versus 2018 and to compare these with trends observed in the United States and Australia using universal criteria for grading of periodontal severity. Materials and methods A retrospective analysis of 369 charts from four Norwegian periodontics clinics was completed. Data on year of referral, gender, age, tobacco smoking, periodontal status and missing teeth at initial examination, teeth planned for extraction, and periodontal case type were collected using a survey format; case type I, II, III, and IV representing increasing severity of periodontitis, case type V representing referral for other periodontal conditions (peri‐implantitis, refractory periodontitis, etc.). Chi‐square, t‐tests, and negative binomial regression were used for the statistical analysis. Results Compared with 2003, the 2018 data showed an increase in mean age at referral (p

Abstract Background A single-entry model in healthcare consolidates waiting lists through a central intake and allows patients to see the next available health care provider based on the prioritization. This study aimed to examine whether and to what extent the prioritization reduced wait times for hip and knee replacement surgeries. Method The survival regression method was used to estimate the effects of priority levels on wait times for consultation and surgery for hip and knee replacements. The sample data included patients who were referred to the Orthopedic Central Intake clinic at the Eastern Health region of Newfoundland and Labrador and had surgery of hip and knee replacements between 2011 and 2019. Result After adjusting for covariates, the hazard of having consultation booked was greater in patients with priority 1 and 2 than those in priority 3 when and at 90 days after the referral was made for both hip and knee replacements. Regarding wait time for surgery after the decision for surgery was made, while the hazard of having surgery was lower in priority 2 than in priority 3 when and indifferent at 182 days after the decision was made, it was not significantly different between priority 1 and priority 3 among hip replacement patients. Priority levels were not significantly related to the hazard of having surgery for a knee replacement after the decision for surgery was made. Overall, the hazard of having surgery after the referral was made by a primary care physician was greater for patients in high priority than those in low priority. Preferring a specific surgeon indicated at referral was found to delay consultation and it was not significantly related to the total wait time for surgery. Incomplete referral forms prolonged wait time for consultation and patients under age 65 had a longer total wait time than those aged 65 or above. Conclusion Patients with high priority could have a consultation booked earlier than those with low priority and prioritization in a single entrance model shortens the total wait time for surgery. However, the association between priority levels and wait for surgery after the decision for surgery was made has not well-established.

Abstract Introduction: The goal of a research ethics consultation service (RECS) is to assist relevant parties in navigating the ethical issues they encounter in conduct of research. The goal of this survey was to describe the current landscape of research ethics consultation and document if and how it has changed over the last decade. Methods: The survey instrument was based on the survey previously circulated. We included a number of survey domains from the previous survey with the goal of direct comparison of outcomes. The survey was sent to 57 RECS in the USA and Canada. Results: Forty-nine surveys were completed for an overall response rate of 86%. With the passing of 10 years, the volume of consults received by RECS surveyed has increased. The number of consults received by a subset of RECS remains low. RECS continues to receive requests for consults from a wide range of stakeholders. About a quarter of RECS surveyed actively evaluate their services, primarily through satisfaction surveys routinely shared with requestors. The number of RECS evaluating their services has increased. We identified a group of eight key competencies respondents find as key to providing RECS. Conclusions: The findings from our survey demonstrate that there have been growth and development of RECS since 2010. Further developing evaluation and competency guidelines will help existing RECS continue to grow and facilitate newly established RECS maturation. Both will allow RECS personnel to better serve their institutions and add value to the research conducted.

Introduction: Due to the increase in COVID-19 patients during the pandemic, the workload of emergency departments has increased. The profile of the patients seeking non-COVID medical care has changed significantly because of the pandemic including the dermatological emergencies. Objective: The aim was to evaluate and compare adult dermatological emergency consultations during the COVID-19 period with pre-pandemic period. Methods:Consulted patients from ED to dermatology between March 11, 2019, and March 11, 2021 were included (Pre-pandemic and pandemic) Age, gender, zone of triage, consultation hour, consultation date, consultation response time, ICD-10 codes were recorded. Results: The total number of consultations were 639. The mean age of the patients in the pre-pandemic period was 44.4 and 46.1 in the pandemic period. The mean consultation response time in the pre-pandemic period was 44.4 minutes and 60.3 minutes in the pandemic. In the pre-pandemic period, the most common consulted diseases were herpes zoster, urticaria, and allergic contact dermatitis. In the pandemic, the most common consulted diseases were herpes zoster, dermatitis other, and urticaria.There was a statistically significant difference of the incidence of other dermatitis, impetigo/folliculitis, cutaneous vasculitis, and pruritus (p

The 2018 Association of Pathology Chairs annual meeting included a panel discussion of Association of Pathology Chairs senior fellows (former chairs of academic departments of pathology who have remained active in Association of Pathology Chairs) about the type of advice that current (sitting) pathology chairs ask them. To inform the panel discussion, information was obtained from the senior fellows by e-mail and subsequent conference call. Of the 33 respondents, 24 (73%) had provided consultation advice (9, 20). Most (>75%) of the consultations were provided face-to-face and outside the framework of Association of Pathology Chairs, with 70% of those seeking advice being well known by the consultant(s). Of the senior fellows providing advice, 71% had themselves sought consultation from former pathology chairs and 75% from nonpathology chairs. Modest correlation was found between the number of consultations senior fellows sought when they were chairs and the number of consultations they subsequently provided. The most frequent topics of consultation were strategic planning, balancing the missions, setting department priorities, recruitment of faculty and staff, conflict management, issues specific to new chairs, and resource (money/space) issues. Those who had provided such advice the longest and to the most people indicated that there was no significant change in the type of questions asked over time. Former department chairs can be a valuable source of counseling for current chairs, and organizations of department chairs should consider formalizing the use of these individuals as consultants to sitting chairs.

The 2018 Association of Pathology Chairs annual meeting included a panel discussion of Association of Pathology Chairs senior fellows (former chairs of academic departments of pathology who have remained active in Association of Pathology Chairs) about the type of advice that current (sitting) pathology chairs ask them. To inform the panel discussion, information was obtained from the senior fellows by e-mail and subsequent conference call. Of the 33 respondents, 24 (73%) had provided consultation advice (9, 20). Most (>75%) of the consultations were provided face-to-face and outside the framework of Association of Pathology Chairs, with 70% of those seeking advice being well known by the consultant(s). Of the senior fellows providing advice, 71% had themselves sought consultation from former pathology chairs and 75% from nonpathology chairs. Modest correlation was found between the number of consultations senior fellows sought when they were chairs and the number of consultations they subsequently provided. The most frequent topics of consultation were strategic planning, balancing the missions, setting department priorities, recruitment of faculty and staff, conflict management, issues specific to new chairs, and resource (money/space) issues. Those who had provided such advice the longest and to the most people indicated that there was no significant change in the type of questions asked over time. Former department chairs can be a valuable source of counseling for current chairs, and organizations of department chairs should consider formalizing the use of these individuals as consultants to sitting chairs.

Objective: Emergency departments (EDs) are medical units that provide healthcare to patients with diseases that have sudden onset symptoms, patients with disorders, or patients with injuries that need immediate care on a 24/7 basis. In addition to emergency patients mentioned above, EDs provide healthcare services to patients who might have an emergency medical situation later, even if their situation is not emergent initially. Emergency medicine physicians perform all resuscitative interventions to stabilize patients, identify patients who need intensive care in an undifferentiated patient pool, and provide the most appropriate treatment to make them suitable for general ward care. Material and Methods: The current study is a retrospective and descriptive study that was conducted by analyzing the computer-based patient records of all patients who were admitted to University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital's Emergency Service between 09.01.2020 and 10.01.2020. All 22,459 patients who were admitted to the ED within one month were included in the study. Age and gender characteristics of the patients who received consultation, departments that made the consultation, and hospitalization rates were determined. Results: The total number of patients who were admitted to the ED between 09.01.2020 and 10.01.2020 was 22,459, the number of consultations was 4,290, and the number of hospitalizations was 1,405. Of the patients for whom consultations were requested, 2,577 were male and 1,713 were female. The mean age was 45.8 years. Of the 22,459 patients who were admitted, 1,786 (7.9%) were triaged with red tags, 9,994 (44.2%) were triaged with yellow tags, and 10,729 (47.9%) were triaged with green tags. The consultations were requested most frequently for orthopedics (522), pulmonology (501), and internal medicine (423). Furthermore, the list continues with general surgery (386); cardiology (335); ophthalmology (321); neurology (299); otorhinolaryngology (250); neurosurgery (204); obstetrics (138); infectious diseases (122); psychiatry (112); thoracic surgery (108); pediatric surgery (79); cardiovascular surgery (73); plastic surgery (71); anesthesiology and reanimation (140); and urology (55) departments. Of the patients for whom consultations were requested, 35.9% were hospitalized in general wards or intensive care units, whereas 64.1% were discharged. Conclusion: This study shows that the number of daily admissions to the emergency room is very high, and it is increasing every day. In order to not disrupt the workflow in the ED, the consultations should be responded quickly. Moreover, if possible, consultants from the high demanding departments, such as orthopedics, pulmonologist, internal diseases, general surgery, cardiology, and ophthalmology should ensure that separate doctors (doctors whose only duty would be to attend patients in their respective departments) are on call for the ED.

Abstract Background Child maltreatment is a major public issue in the United States, yet most children affected by abuse or neglect never engage in evidence-based practices (EBP) for child mental health. Children’s Advocacy Centers (CACs’) are uniquely situated to serve as Family Navigators who connect children impacted by maltreatment to appropriate EBPs. In fact, the CAC position of Victim Advocate mirrors the Mental Health Family Navigator national initiative. Methods The feasibility study protocol is to develop, implement, and evaluate web-based and consultative training for Victim Advocates to enhance early engagement in services (E3 training). The interactive web-based training embeds key targets of knowledge and skills related to family engagement, trauma, and EBP services. Participating CACs were randomized to E3 webinar-based training, E3 webinar plus consultation, or delayed training. The project will test the E3 training’s impact on key mechanisms of change (e.g., knowledge, skills) to improve rates of screening, referral, and access to EBP services. The feasibility of implementing the training program and differential impact and costs by level of training will be examined. Discussion The overarching goal of this project is to test the feasibility of training that is readily implemented through CACs and examine the mechanisms for improving early engagement and, ultimately, child, and adolescent mental health outcomes. Results and cost findings will be used to plan a large-scale comprehensive, mixed-methods hybrid type II effectiveness-implementation and cost-effectiveness trial of family navigator E3 training. If outcomes are positive, considerable infrastructure exists to support the scale-up and sustainability of E3 training nationwide, by embedding the training in national CAC training protocols. Trial registration NCT04221633 Date and version identifier March 25, 2021; Vers. 1.0 (original); September 11, 2021; Vers 2.0 (revision); October 29, 2021; Vers. 3.0 (revision)

Abstract Background Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study. Methods Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied. Results Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p

In the 21st century in Ukraine, there is a large-scale information transformation in all spheres of life, including education. This is a century of large-scale and radical reforms and changes related to the modernization of state support for education and the emergence of new opportunities for the development of educational services. Now, education is the subject of special research in various fields of knowledge based on ICT. There is a growing number of various ranks employees who have the potential skills of consultants, teachers, coaches, advisors, etc., which in parallel can perform the functions of consultants in educational institutions. Therefore, in the modern world, consultation and consulting become relevant and important. The article considers the concepts of «consulting» and «information consulting»; it reveals the features of pedagogical counselling in modern educational activities. It was found that counselling (consulting) is a specially organized information interaction between the counsellor and those who need help to solve the problem and make positive changes in the activities of an individual or organisation as a whole. The necessity of the development of counselling in the field of education in the period of modernization and cardinal changes in society has been substantiated. The main purpose of consulting activities at educational institutions has been elucidated, which involves the dissemination and implementation in this process modern advances in science and technology, providing students and population with advisory services on the use of modern technologies and social development, giving consultations and support for various projects, raising the knowledge level and improving the practical skills of those involved in pedagogical interaction. The specifics, functions (consulting, scientific, research, mediation, training ones), role and main directions of development of consulting activity in educational institutions have been determined. Two primary areas that require the systematic use of consulting services in educational institutions have been analyzed, among them the methodological and career counselling. Pedagogical, socio-pedagogical, psychological and managerial types of educational consulting and related with them the informational, career guidance and reputation types of consulting have been characterized. Promising technologies that can provide full-fledged consulting services have been outlined. They cover computer-based pedagogical technologies and the ones that ensure the proper interaction of participants in the educational process. The difficulties and contradictions inherent in the stage of formation of the information and consulting environment of educational institution and the development of consulting services in the field of education have been considered.

Background: Early palliative care (PC) has shown beneficial effects for advanced cancer patients. However, it is still debated what criteria to use to identify patients for PC referral. Aim: To document the initial steps of the development of the Palliative Care Referral System (PCRS), a tool to be used by oncologists in clinical practice. Methods: A multiprofessional working group developed the PCRS based on the results of a scoping literature review on PC referral criteria. PCRS criteria were evaluated by experts via a nominal group technique (NGT). Descriptive statistics were used to summarize expert scores on relevance, appropriateness and perceived feasibility of the criteria proposed. Quotations of participants during the discussion were also reported. Results: Sixteen studies, including PC referral criteria/tools, emerged from the scoping review. Severe symptoms, poor performance status, comorbidities and prognosis were the most commonly used criteria. The PCRS included nine major criteria and nine assessment methods; a scoring procedure was also proposed. Answers to the questionnaire during the NGT showed that five criteria reached full agreement on all items, while four did not, and were then discussed within the group. Participants agreed on the relevance of all criteria and on the appropriateness of methods proposed to assess most of them, while issues were raised about potential feasibility of the overall assessment of the PCRS in clinical practice. Conclusion: The PCRS has been developed as an help for oncologists to timely identify patients for specialized PC referral. Since feasibility emerged as the main concern, implementation strategies have to be tested in subsequent studies. [ABSTRACT FROM AUTHOR]

Background: Palliative care provision for persons experiencing homelessness is often poor. A threefold consultation service intervention was expected to increase knowledge of palliative care and multidisciplinary collaboration, and improve palliative care for this population. This intervention comprised: 1) consultation of social service professionals by palliative care specialists and vice versa; 2) multidisciplinary meetings with these professionals; and 3) training and education of these professionals. We aimed to evaluate the implementation process and its barriers and facilitators of this service implemented within social services and healthcare organizations in three Dutch regions. Methods: A process evaluation using structured questionnaires among consultants, semi-structured individual and group interviews among professionals involved, and (research) diaries. Qualitative data were analysed using thematic analysis. The process evaluation was structured using the Reach, Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results: All three regions adopted all three activities of the intervention, with differences between the three regions in the start, timing and frequency. During the 21-month implementation period there were 34 consultations, 22 multidisciplinary meetings and 9 training sessions. The professionals reached were mainly social service professionals. Facilitators for adoption of the service were a perceived need for improving palliative care provision and previous acquaintance with other professionals involved, while professionals' limited skills in recognizing, discussing and prioritizing palliative care hindered adoption. Implementation was facilitated by a consultant's expertise in advising professionals and working with persons experiencing homelessness, and hindered by COVID-19 circumstances, staff shortages and lack of knowledge of palliative care in social service facilities. Embedding the service in regular, properly funded meetings was expected to facilitate maintenance, while the limited number of persons involved in this small-scale service was expected to be an obstacle. Conclusions: A threefold intervention aimed at improving palliative care for persons experiencing homelessness is evaluated as being most usable when tailored to specific regions, with bedside and telephone consultations and a combination of palliative care consultants and teams of social service professionals. It is recommended to further implement this region-tailored intervention with palliative care consultants in the lead, and to raise awareness and to remove fear of palliative care provision. [ABSTRACT FROM AUTHOR]

This case note illustrates how mining companies operating in South Africa often resort to retrenchments to bring operational costs under control. Processes leading to such retrenchments are statutorily required by section 189 of the Labour Relations Act to include consultations, principally with trade unions that are part of collective agreements. As evidenced by the analysis of the Association of Mine Workers and Construction Union and others v Royal Bafokeng Platinum Limited and Others, the said statutory requirement is problematic and divisive as even the Constitutional Court became very divided as to whether the provision regulating retrenchment processes is constitutionally valid. With a slim majority of judges finding the provision constitutional, this case note highlights reasons why such division must be addressed in the interest of affected employees excluded from retrenchment negotiations. [ABSTRACT FROM AUTHOR]

Assuring treatment plan implementation following consultation is critically important because implementation is strongly related to outcomes. Treatment implementation has been hypothesized to be influenced by both the nature of the follow-up support provided and contextual variables. However, studies to date have not examined both issues while directly measuring implementation. This study examined treatment implementation following consultation for 48 teachers in public schools who had referred a student for intervention services in a randomized clinical field trial. Participating teachers in the experimental group received Integrated Support (IS). IS includes social influence, planning, and performance feedback elements. IS was compared to weekly follow-up meetings alone. Treatment implementation and child outcomes were markedly superior for IS as compared to weekly follow-up. Three school climate factors were found to be correlated with treatment implementation for the IS group, but not the weekly follow-up group. Participants rated treatment implementation, treatment acceptability, and consultant effectiveness positively and similarly across conditions. The implications of these findings for future work examining school culture, consultation and intervention are discussed. [ABSTRACT FROM AUTHOR]

• Therapy delivered in a culturally responsive way can lead to better outcomes. • Consultation is of critical importance in clinical skill development. • Multicultural counseling principles can be integrated into all aspects of training. The use of multicultural principles to enhance cognitive behavioral therapy (CBT) for individuals of marginalized backgrounds has received increased attention in light of the heightened national awareness of systemic oppression and racialized violence directed towards Black, Indigenous, and People of Color. However, there has been less of a focus on applying such principles to consultation for skill development. If ethical guidelines are expected to influence the behavior of clinicians in session, guidance is needed to indicate how and where and when clinicians should receive training in implementing culturally responsive CBT. Individual reading and reflection are necessary but are not sufficient in acquiring new clinical skills. Consultation is recommended and strongly suggested when clinicians are working with new populations or delivering a new treatment, or even using a new modality. Consultation can also be useful when adopting a new approach or stance to therapy. For practicing clinicians who have not developed these skills, additional consultation can and should be used to address this gap. Moving forward, integration of cultural responsiveness into standard consultation will ensure that these skills are seen as a core competency, rather than an optional additional skill that may be (or not be) elected. This paper presents core experiences that may be integral to a CBT consultation model that aims to enhance providers' ability to provide CBT in a way that is culturally responsive to their clients. These recommendations attend to both content and process within CBT consultation and reflect guiding assumptions for helping clinicians to develop the ability to practice CBT in a culturally responsive manner, including (a) normalizing discussions of cultural identity and oppression, (b) an emphasis on cultural self-awareness, (c) emphasizing culturally informed CBT case conceptualization, and (d) skill development in applying cultural elements to CBT interventions. [ABSTRACT FROM AUTHOR]

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Purpose: This study was conducted as a randomized controlled trial to determine the effects of e-mobile training and consultancy services on self-care agency, body image, and quality of life in patients undergoing bariatric surgery. Material and Methods: This study was conducted as a randomized controlled interventional study. The sample of the study consisted of 51 patients who met the sample selection criteria and volunteered to participate in the study in the Obesity Center of a City Hospital. The patients in the experimental group received e-mobile training and consultancy services with a mobile application developed specifically for bariatric surgery that started before the operation and lasted for 3 months after the operation. CONSORT checklist was used to report the current study. Results: A statistically significant difference was found in the mean scores of Self-Care Agency Scale, Body Image Scale, Moorehead-Ardelt Quality of Life II, and BMI of the patients in the experimental and control groups according to the processes (p < 0.05). There was no statistically significant difference between the groups in terms of preoperative, 1st, 2nd, and 3rd months of Self-Care Agency, Body Image, and Quality of Life scale mean scores (p > 0.05). There was a statistically significant difference between the groups in favor of the experimental group in terms of the 1st, 2nd, and 3rd month BMI averages (p < 0.05). Conclusions: The findings indicate that e-mobile training and consultation services given to patients undergoing bariatric surgery were effective in BMI measurements, but not on self-care agency, body image, and quality of life. Trial Registration: ClinicalTrials.gov Identifier: NCT05278767. [ABSTRACT FROM AUTHOR]

There has been interest in using social media for consumer engagement in hospitals, particularly for service design and quality improvement, but services have identified a need for guidance. This article outlines the methods used to involve stakeholders in the development of a guide for the use of social media as a consumer engagement tool for Australian public hospitals, and describes the changes to the guide and implementation findings that resulted from stakeholder involvement. The development of the guide involved cycles of two interrelated methods – (1) small group co-creation involving three hospital consumer representatives, three service provider representatives and three academics gathering and analysing data, and integrating findings into the development of the guide; and (2) a consultation with eighteen hospital stakeholders who provided feedback on versions of the guide throughout its development. Participants were encouraged to use their experience as service providers and consumers to reflect broadly on how the content and design of the guide could support social media-based consumer engagement within their particular setting. The co-creation and consultation methods led to four main feedback themes: (1) Enhancing usability is critical for guidance resources ; (2) Executive support and teamwork are essential for implementation ; (3) Start small and build experience and knowledge over time ; and (4) Thinking about new methods brings up questions around existing practice. Involving stakeholders in the design process through co-creation and consultation methods led to critical changes to the guide, enhancing its usability and creating a focus in the guide on building organisational and individual capacity around service design and improvement. Involving stakeholders in the development of the guide also allowed us to translate existing research knowledge into practical implementation strategies and tools, and may increase the likelihood of the guide being used by hospitals, providers and consumers. [ABSTRACT FROM AUTHOR]

Background: Self-management is key for reducing the burden of disease in chronical illness. However, applying self-management presupposes behavioral change. Sufficient knowledge, skills, confidence and motivation to make the needed behavior changes are important prerequisites. During the past years the Integral Diagnostic Trajectory was developed for patients with asthma or COPD which aims to identify treatable traits and activating patients for self-management. Objective: In the present study the effects of the Integral Diagnostic Trajectory on the Patient Activation Measure (PAMR) were examined. In addition, predictive variables for PAM baseline scores and change scores were sought. Materials and methods: A total of 241 patients with asthma or COPD referred to the pulmonologist at the Radboud university medical center, location Dekkerswald, Nijmegen were included. Patient activation was measured before the first visit and after the intervention with the 13-item PAMR . Additional, patient characteristics and health status were measured with the Nijmegen Clinical Screening Instrument (NCSI), modified Medical Research Council (mMRC), Asthma Control Questionnaire (ACQ), and COPD Clinical Questionnaire (CCQ). Results: Fifty percent of the patients with asthma and seventy percent of the patients with COPD had low levels of activation at baseline (PAM level 1-2). Baseline PAM scores could be explained in patients with asthma for 7% by number of severe problems in health status. And for 18% in patients with COPD by number of severe problems, age and employment status. After the intervention both groups significantly improved on the PAM (T0: 56.0 -- 13.1 vs. T1:63.3 -- 14.0 in asthma, and T0: 50.0 -- 8.8 vs. 58.4 -- 11.1 in COPD). Multivariate stepwise regression analysis showed that only 24% of the change in score could be explained by baseline PAM score and being employed in patients with asthma, and 18% of the variance in change score could be predicted by baseline PAM score in COPD. Conclusion: The present study showed that low level of activation is a common feature in patients with asthma and COPD. With a relatively short and seemingly simple intervention patients can reach higher levels of patient activation, which is a prerequisite for adopting self-management techniques in daily life. [ABSTRACT FROM AUTHOR]

Purpose: To characterize the healthcare utilization and clinical characteristics of patients presenting with flashes and/or floaters (F/F) in general emergency service (GES) settings.Methods: All adults presenting to GESs (emergency departments (EDs) and urgent care centers (UCCs)) with symptoms of F/F in Hamilton, Ontario between Jan. 1 - Dec. 31, 2018 were reviewed. Primary outcome was the proportion of patients presenting to GESs with F/F for which ophthalmology emergency services (OESs) were consulted. Secondary outcomes included features predictive of OES consultation by logistic regression and cost of GES utilization.Results: Of 6590 primary eye-related visits to GESs, 10.4% (687) involved symptoms of F/F. Mean age of patients with F/F was 57 ± 15 years, and 61% were female. Consultation rate to OESs for F/F presentations was 89% (608/687). Logistic regression identified symptoms ≤ 2 weeks (OR 8.0; 95% CI 2.3-28), ≥ 45 years age (OR 2.4; 95% CI 1.4-4.3), UCC setting (OR 2.7; 95% CI 1.6-4.6), headache (OR 0.22; 95% CI 0.12-0.41), and neurologic symptoms (OR 0.1; 95% CI 0.19-0.49) as variables predictive of OES consultation. Mean time from triage to discharge in GESs for F/F patients was 2.43 ± 2.36 h. Mean cost per visit was $139.11 ± $113.93 Canadian dollars. Patients for which OES were consulted waited a total of 1345 h in GESs and accounted for $81,879.70 in costs.Conclusion: Patients presenting with F/F in GESs consume considerable resources in healthcare expenditure and time spent in GESs and most receive OES consultation. Identifying these patients at triage may allow for increased efficiency for the healthcare system and patients. [ABSTRACT FROM AUTHOR]

Psychological consultation is one way of reaching a greater number of families with limited resources, yet little is known about the benefits and challenges of this intervention in adoption. We qualitatively explored consultations provided to adoption social workers by clinical psychologists. Six social workers and four clinical psychologists participated in semi-structured interviews. Five themes with supporting sub-themes were identified: (1) A context of highly emotive work with scarce resources; (2) consultations draw on Dyadic Developmental Practice and systemic thinking and involve goal-oriented and interpersonal processes; (3) consultations experienced as valuable despite challenges; (4) consultations facilitate learning for both social workers and psychologists; and (5) a collaborative focus and the 'expert role'. Our findings suggest consultation is experienced positively by social workers and psychologists, that it successfully facilitates the transfer of psychological knowledge, and has the potential to enhance multi-agency working. Future research needs to better understand the impact of consultation on adoptive families. [ABSTRACT FROM AUTHOR]

Purpose: To assess the COVID-19 exposure risk to consulting ophthalmologists and the pandemic effect on consultations at one of the most impacted hospital systems in New York. Methods: In a retrospective, cross-sectional study, ophthalmology consult notes and COVID-19 test results were collected from the electronic medical record from February to May in 2019 and 2020. Results: Of 2,215 total notes analyzed, consults decreased from 1,374 to 841 between years (p = 0.0002). In 2020, 22.5% of all consults were COVID tested and 2.4% were positive within 2 weeks of in-person evaluation. In 2020, 1.8% of consults were electronic. Ventilated patients increased between years (7.5% to 10.8%; p = 0.04). Conclusions: Although consultations decreased during the Spring 2020 peak, the majority (98.2%) remained as in-person evaluations. While few patients tested COVID positive, this likely reflects the limited availability of testing early in the pandemic. Consulting ophthalmologists remained at high risk of COVID-19 exposure during the pandemic peak. [ABSTRACT FROM AUTHOR]

This paper shows how the commitment of senior leadership teams to student voice is not necessarily shared by teachers. As part of a wider study, this paper presents qualitative data generated through interviews with school staff in one Irish post-primary school with a strong culture of student voice to illustrate the discrepancy that can exist between senior leaders and teachers in terms of how they embrace, enact, and experience student voice. Student voice customs can be rhetorical, perhaps even exaggerated by some, and peripheral to others, and positions on student voice are often determined by positions in the school hierarchy. As student voice remains considerably underdeveloped in Irish post-primary schools despite Irish education and most Irish schools becoming replete with student-centred discourses, this paper provides one possible way of making sense of the current state of play. More broadly, it points to how different actors work on and with student voice in different ways. [ABSTRACT FROM AUTHOR]

Most calls to poison information centers are from the public, pertaining to young children, and due to minor or nontoxic exposures. Rational poison center consultations can prevent unnecessary visits to emergency departments (EDs), callers' adherence to such advice is required. Estimate adherence of callers from the public to the poison center concerning exposures of young children to the advice provided by the clinical toxicologist, estimate the number of unnecessary ED visits of these children prevented by poison center consultations. Prospective, phone-survey cohort study. Calls from the public concerning children under 6 years old were recorded and collected, telephone follow-up was performed within two weeks. Data collected included: demographics, exposure, severity, triage advised, adherence to the advice, reasons for nonadherence, and what the caller would have done had the poison center been unavailable. The study was conducted over 3 months representing different seasons and holidays times during a 1-year period. 1762 callers completed the telephone follow-up; 1443 (81.9%) cases were asymptomatic at the time of call; 1452 (82.3%) were advised to remain at home, 175 (9.9%) and 137 (7.8%) were referred to community clinics and EDs, respectively; 1648 (93.5%) of callers adhered to the advice provided; highest adherence rate was among callers advised to stay home (98.3%, 1427), and 78.9% (108) and 62.1% (109) among callers referred to EDs and community clinics, respectively. Among callers advised to stay home, 491 stated that they would have referred themselves to the ED had the poison center been unavailable, an annual estimate of 4309 cases. The main parameter predicting nonadherence was calls made during night shift. The high adherence of callers to the poison center consultation suggests it plays an important role in preventing unnecessary ED visits of young children due to poison exposures, and may substantially reduce ED load and costs. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of diabetes is increasing around the world, especially in populations with limited health service resources. Diabetes is associated with increased mortality and cost. Therefore, we investigated the impact of increasing access to diabetes care through telemedicine.Methods: Five rural communities were connected via videoconference. Patients received diabetes consultation (DC) or diabetes self-management education (DSME). DC was performed by an endocrinologist, while DSME was delivered by a certified diabetes educator. Haemoglobin A1c (HbA1c), blood pressure (BP) and lipid profile were evaluated as outcome measures.Results: Sixty-nine subjects (70% females, 91% Caucasians) were studied, with 33 receiving DC and 36 receiving DSME. Patients were aged 56.7 ± 9.4 and 56.5 ± 6.7 years, respectively (p > 0.5), and had had diabetes for 11.4 ± 10.1 and 11.7 ± 9.2 years, respectively (p > 0.5). Both DC and DSME reduced HbA1c equally: DC at baseline 9.3 ± 1.3% compared to at 12 months 7.2 ± 0.9% (p = 0.0002), and DSME at baseline 9.8 ± 1.6% compared to at 12 months 8.3 ± 1.9% (p = 0.009). There was no difference in HbA1c between DC and DSME at baseline and at 12 months (p > 0.1). On the average, BP and lipids were equally controlled in DC and DSME at six months: total cholesterol 178.3 ± 50.5 mg/dL versus 185.9 ± 57.3 mg/dL, low-density lipoprotein cholesterol 91.4 ± 36.1 mg/dL versus 91.5 ± 50.2 mg/dL, high-density lipoprotein cholesterol 46.2 ± 11.0 mg/dL versus 43.5 ± 10.8 mg/dL, systolic BP 136.8 ± 23.6 mmHg versus 131.9 ± 22.3 mmHg, diastolic BP 72.0 ± 13.2 mmHg versus 77.7 ± 11.3 mmHg (p > 0.1). All subjects found DC and DSME cost effective, while 97% reported better diabetes control.Discussion: In patients with long-standing uncontrolled diabetes who lived in rural communities with high diabetes-related mortality rates, DC or DSME delivered by videoconference improved glycemic control. No difference was found between the two interventions. [ABSTRACT FROM AUTHOR]

The study aims to analyze one of the principles governing public administration, namely the principle of consultation. The Administrative Code doesn't enshrine it, under this name, among the general principles of public administration, which are provided for by title III of its first part. It results from the way in which the principle of transparency is defined. But the principle is mentioned by art. 75 of the Administrative Code, through the formula „the principle of consultation in solving problems of particular local interest". Both meanings of the principle will be analyzed, both the one that concerns the consultation and public debate of draft normative acts, as well as the consultation of members of local communities and the state on local or national issues of particular interest. [ABSTRACT FROM AUTHOR]

Introduction: Remote consultations help reduce contact between people and prevent cross-contamination. Little is known about the changes in consultation in European rural primary care during the SARS-CoV-2 (COVID-19) pandemic. The purpose of this mixed-methods cross-sectional study was to find out more about the effects of the pandemic on changes in patient consultations in European rural primary care. Methods: A key informant survey from 16 member countries of the European Rural and Isolated Practitioners Association (EURIPA) was undertaken using a self-developed questionnaire. The steering committee of this project, called EURIPA Covid-19 study, developed a semi-structured questionnaire with 68 questions, 21 of which included free-text comments. Proportions were calculated for dichotomized or categorized data, and means were calculated for continuous data. Multivariate analysis by logistic regression model was used to assess the association of multiple variables. Results: A total of 406 questionnaires from primary care providers (PCPs) in 16 European countries were collected; 245 respondents (60.5%) were females, 152 PCPs were rural (37.5%), 124 semi-rural (30.5%). Mean age of the respondents was 45.9 years (standard deviation (SD) 11.30) while mean seniority (length of experience) was 18.2 years (SD 11.6). A total of 381 (93.8%) respondents were medical doctors. Significant differences were found between countries in adopting alternative arrangements to face-to-face consultation: remote teleconsultation is well appreciated by both healthcare professionals and patients, but the most common way of remote consultation remains telephone consultation. A factor significantly inversely associated with the adoption of video consultation was the seniority of the PCP (odds ratio 1.19, 95% confidence interval 1.02-1.40, p=0.03). Conclusion: Telephone consultation is the most common form of remote consultation. The adoption of video-consultation is inversely related to the seniority of the informants. [ABSTRACT FROM AUTHOR]

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In two recent South African cases, the applicants sought interim interdicts preventing the respondent companies – Shell and Searcher – from continuing with, or alternatively commencing, their seismic surveys along the eastern and the western/southwestern coasts of South Africa respectively. In both matters, rights in relation to searching for mineral or petroleum resources had been granted in terms of the Mineral and Petroleum Resources Development Act 28 of 2002. The High Courts paid special attention to the inadequate public consultation processes that had been followed and highlighted the duty of Shell and Searcher to meaningfully consult with the affected communities and individuals. In both cases, the Courts found that the requirements for an interim interdict had been met, and Shell and Searcher were accordingly prohibited from continuing with or commencing their seismic surveys of the respective portions of the South African coast, pending the outcomes of the main applications. [ABSTRACT FROM AUTHOR]

Heritage conservation's modernist underpinnings limit engagement with heritage value, resulting in incompatible additions to historic places. A good example is the controversy surrounding the proposed addition to the Château Laurier National Historic Site in Ottawa, Canada, designed by Peter Clewes and approved by the City of Ottawa in February 2021. The addition's defenders used the Standards and Guidelines for the Conservation of Historic Places in Canada's modern dictums, particularly legibility and the supremacy of expert knowledge, to justify the Neo-Modernist addition against public outcry. This paper defends the public's cries for a more fanciful, historicist addition. It argues that additions to historic places should be more than visually and physically compatible. Additions to heritage sites should be stylistically and intellectually compatible and engaged in dialogue with a site's heritage values. It asks, what do new additions communicate about the original historic site? How do they help or hinder our understanding of the site's social or historical significance? Designers and evaluators of new additions should ask themselves these questions. They should more closely consider the impact of new additions on historic places' heritage values. Such consideration may reduce friction between practitioners and the wider public. [ABSTRACT FROM AUTHOR]

Background Infectious diseases (ID) consultation improves health outcomes for certain infections but has not been well described for Pseudomonas aeruginosa (PA) bloodstream infection (BSI). Therefore, the goal of this study was to examine ID consultation of inpatients with PA BSI and factors impacting outcomes. Methods This was a retrospective cohort study from January 1, 2012, to December 31, 2018, of adult hospitalized veterans with PA BSI and antibiotic treatment 2 days before through 5 days after the culture date. Multidrug-resistant (MDR) cultures were defined as cultures with resistance to at least 1 agent in ≥3 antimicrobial categories tested. Multivariable logistic regression models were fit to assess the impact of ID consults and adequate treatment on mortality. Results A total of 3256 patients had PA BSI, of whom 367 (11.3%) were multidrug resistant (MDR). Most were male (97.5%), over 65 years old (71.2%), and White (70.9%). Nearly one-fourth (n = 784, 23.3%) died during hospitalization, and 870 (25.8%) died within 30 days of their culture. Adjusted models showed that ID consultation was associated with decreased in-hospital (odds ratio [OR], 0.47; 95% CI, 0.39–0.56) and 30-day mortality (OR, 0.51; 95% CI, 0.42–0.62). Conclusions Consultation with ID physicians improves clinical outcomes such as in-hospital and 30-day mortality for patients with PA BSI. ID consultation provides value and should be considered for patients with PA BSI. [ABSTRACT FROM AUTHOR]

The oldest canoe discovered in South Carolina was illegally recovered from the Cooper River near Charleston in 1997 and spent 23 years in state custody awaiting funding for conservation treatment. In 2020, it was transferred into the temporary custody of Clemson University's Warren Lasch Conservation Center. Where once the conservation methodology would have begun and ended with an impregnation treatment and vacuum freeze-drying, the Cooper River Canoe Project instead began by consultation with the Native American communities of South Carolina. Through collaboration with Native American leaders, archaeologists, and conservators, the conservation of a 4000-year-old, waterlogged, fragmentary dugout canoe will be undertaken. Unprecedented in South Carolina, the Cooper River Canoe Project challenges established colonial practices in archaeology and conservation, and designs a new approach to the conservation of Native American cultural heritage. By recognizing Native American communities' rights to the management and determination of their cultural heritage, project partners are creating a new model for the conservation of cultural heritage in South Carolina. [ABSTRACT FROM AUTHOR]

Objective: Since skin diseases may show atypical presentation in children, histopathological evaluation plays a more critical role. The aim of this study is to determine the diagnoses that are finalized after the histopathological evaluation, which departments are frequently consulted, and the methods of follow-up in pediatric dermatology. Materials and Methods: This cross-sectional study was conducted on pediatric and adolescent patients whose biopsy was taken after evaluation in the pediatric dermatology outpatient clinic for 42 months. Results: Of the pediatric patients whose histopathological evaluation was made, 16.7% were consulted to other departments and 70.8% were followed up in the pediatric dermatology clinic with different methods. According to the histopathological evaluation results, 91.9% of the lesions were benign, 5.6% were premalignant, and only 1.5% were malignant. Three patients (1.5%) with malignant lesions in our pediatric dermatology clinic were followed up with pediatric dermatology and pediatric hematology. In comparison, premalignant lesions of 3 patients were excised in pediatric dermatology surgery; 6 patients were excised in plastic surgery, 1 patient in pediatric surgery, and 1 patient in ophthalmology. Conclusion: Pediatric dermatology is a department that should have pediatric dermatopathology and pediatric dermatosurgery units in itself. It is crucial to be in the teamwork for consultations and follow-ups after histopathological examinations. [ABSTRACT FROM AUTHOR]

Objectives: An observation of the Emergency Room (ER) admissions during the lockdown. Methods: We monitored admissions to the ER requiring psychiatric evaluation during the 2020 lockdown (March 9th-May 3rd, 2020) compared to the same period of 2019, in four sites of Northern Italy (ASST Lariana, AUSL Modena, ASU Friuli Centrale and AUSL Romagna). Number of admissions, baseline demographic and clinical variables were extracted from the clinical databases. Results: A 20.0% reduction of psychiatric referrals was observed across the sites (24.2% in ASST Lariana, 30.5% in AUSL Modena, 12.0% in ASU Friuli Centrale and 14.5% in AUSL Romagna). This reduction peaked at 41.5% in the first month of the lockdown. Being homeless as well as with a dual diagnosis (OR 1,67, CI: 1.02–2.74), while living in a residential facility and admission for a depressive episode Being homeless (OR 2.50, CI: 1.36–4.61) and having a dual diagnosis (OR 1,67, CI: 1.02–2.74) were significantly associated with an increase in ER admission, while living in a residential facility (OR 0.48, CI: 0.31–0.74), having a depressive episode (OR 0.36, CI: 0.18–0.73) and a diagnosis of anxiety disorder (OR 0.60, CI: 0.36–0.99) were significantly associated with a decrease. Conclusions: During lockdown, a decrease in psychiatric referrals was observed. [ABSTRACT FROM AUTHOR]

Traditionally, school-based preventative frameworks have been implemented in isolation with little consideration of alignment and integration of practices throughout the school day. The present study aims to address this gap by increasing school psychologists' preventative involvement with consultation in early childhood school settings. Using an integrated approach through a multiple baseline design, four Head Start educators were trained in classroom management practices, to increase opportunities throughout the day for teaching, prompting, and reinforcing key skills taught through the Second Step Early Learning (SSEL) social emotional learning curriculum. Findings suggest that a brief professional development session (1-hour) followed by weekly performance feedback (15 minutes) largely increased educator use of aligning classroom management strategies with weekly SSEL lessons (ES = .94, p-value = <.000). Effects on challenging behavior were limited, although two classrooms demonstrated an overall decrease in challenging behavior (ES = -.20). Results further indicate this intervention increased feelings of teacher self-efficacy and was a socially valid approach; educators reported the aligned strategies were acceptable, sustainable, and beneficial to children. Limitations and implications of this study are further discussed with suggested directions for future research. [ABSTRACT FROM AUTHOR]

Introduction: Heart failure (HF) poses a burden on specialist care, making referral of clinically stable HF patients to primary care a desirable goal. However, a structured approach to guide patient referral is lacking. Methods: The Maastricht Instability Score—Heart Failure (MIS-HF) questionnaire was developed to objectively stratify the clinical status of HF patients: patients with a low MIS-HF (0–2 points, indicating a stable clinical condition) were considered for treatment in primary care, whereas high scores (> 2 points) indicated the need for specialised care. The MIS-HF was evaluated in 637 consecutive HF patients presenting between 2015 and 2018 at Maastricht University Medical Centre. Results: Of the 637 patients, 329 (52%) had a low score and 205 of these 329 (62%) patients were referred to primary care. The remaining 124 (38%) patients remained in secondary care. Of the 308 (48%) patients with a high score (> 2 points), 265 (86%) remained in secondary care and 41 (14%) were referred to primary care. The primary composite endpoint (mortality, cardiac hospital admissions) occurred more frequently in patients with a high compared to those with a low MIS-HF after 1 year of follow-up (29.2% vs 10.9%; odds ratio (OR) 3.36, 95% confidence interval (CI) 2.20–5.14). No significant difference in the composite endpoint (9.8% vs 12.9%; OR 0.73, 95% CI 0.36–1.47) was found between patients with a low MIS-HF treated in primary versus secondary care. Conclusion: The MIS-HF questionnaire may improve referral policies, as it helps to identify HF patients that can safely be referred to primary care. [ABSTRACT FROM AUTHOR]

There are higher courts in every country. The Courts perform many types of functions. The Courts protect the rights of citizens and decide the controversy between the Center and States. It maintains the federal and basic structures of the Constitution. But it is not possible without independent and meritorious judges. So, there is a mechanism for the appointment of such judges. The Indian Constitution also envisages a method of appointment of the Supreme Court and the High Courts' judges. But there is a conflict between the executive and the judiciary regarding the power of higher judges' appointments in India. Many judgments were delivered to settle this controversy. The Indian Parliament also enacted some statutes. But, even these could not solve the problem. The researchers, in the article, will discuss these controversies systematically. They will search the pros and cons of the 'collegium' and the National Judicial Appointment Commission. They will also suggest a suitable mechanism for appointing independent and competent judges in India. [ABSTRACT FROM AUTHOR]