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1
Spurrell, Mark. "Consultant learning groups in psychiatry." Psychiatric Bulletin 24, no. 10 (2000): 390–92. http://dx.doi.org/10.1192/pb.24.10.390.
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There is growing emphasis on the importance of continuing professional development (CPD) for consultant psychiatrists and an increasing recognition of the need for peer support. In this context the Royal College of Psychiatrists has been developing policy around CPD; a policy document has been issued by The College Council (Royal College of Psychiatrists, 1994) and there are regular updates on this topic on the website (www.rcpsych.ac.uk). All consultants are to be expected to take part in CPD and currently the annual requirement is for 20 hours of ‘external’ CPD and 30 hours of ‘internal’ CPD. ‘External’ refers to didactic or workshop events that involve input from outside a clinician's locality; ‘internal’ refers to local activities, case conferences, journal clubs, etc. CPD follows a 5-year rolling cycle, supported by the journal Advances in Psychiatric Treatment, a recommended 2 hours per week personal study and the development of personal development plans. From the outset there appear to have been issues in engaging consultants in CPD (Morgan, 1998). The problems of establishing CPD extend beyond consultants ‘finding the time’.
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Tucker, William, Mark Olfson, Steven Simring, William Goodman, and Scott Bienenfeld. "A Pilot Survey of Inmate Preferences for On-Site, Visiting Consultant, and Telemedicine Psychiatric Services." CNS Spectrums 11, no. 10 (2006): 783–87. http://dx.doi.org/10.1017/s1092852900014905.
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ABSTRACTObjectiveTo assess inmate preferences for in-prison mental health services, outside psychiatric consultants, and telemedicine psychiatric consultation for 16 mental health services.MethodsStructured interviews were conducted of the service modality preferences of 28 inmates who received psychiatric telemedicine consultations in NewYork State Department of Corrections facilities.ResultsFor five of the 16 mental health services assessed, a significantly larger proportion of inmates preferred delivery of mental services by their on-site mental health team to an outside psychiatric consultant, whether visiting or using telemedicine. For another eight services, inmate preferences were approximately equal. For three services (treatment progress, evaluation of childhood sexual abuse, and sexual concerns), inmates reported a trend toward preference for out-side consultation (visiting and telemedicine combined). For no service did inmates prefer telemedicine to a visiting consultant.ConclusionAlthough inmates prefer the use of on-site mental health professionals for many mental health services, some inmates prefer visiting or telemedicine consultants for the evaluation of safety and sexual issues. Because telemedicine is efficient and readily available, its role in these areas requires further evaluation.
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Murdoch, Jane M., and John M. Eagles. "‘Stress-busting’ groups for consultant psychiatrists." Psychiatric Bulletin 31, no. 4 (2007): 128–31. http://dx.doi.org/10.1192/pb.bp.106.010934.
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Aims and MethodTo describe the formation and function of ‘stress-busting’ groups and report a survey on work-related stress among a small cohort of consultant psychiatrists.ResultsOf 37 questionnaires, 25 were returned and 16 respondents (64%) rated their overall level of stress at work as moderate or severe. Stressful factors included lack of staff, paperwork, high-risk patients, difficult/hostile relatives and job demands interfering with family life. The most helpful stress-reducing strategies were talking to colleagues for support and catharsis, outside interests, support from family and friends, effective time management and exercise. Among 15 current members of ‘stress-busting’ groups, 14 (93%) found these to be helpful. The most successful format in the ‘stress-busting’ groups was one of ‘problem-solving with ventilation of stresses'.Clinical Implications‘Stress-busting’ groups may constitute a helpful approach to work-related stress and a utilisation of the skills of psychiatrists to our mutual benefit.
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Courvoisier, D., K. Lauper, S. A. Bergstra, et al. "OP0199 POINTS TO CONSIDER WHEN ANALYSING AND REPORTING COMPARATIVE EFFECTIVENESS RESEARCH WITH OBSERVATIONAL DATA IN RHEUMATOLOGY." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 124–25. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1162.
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Background:Comparing drug effectiveness in observational settings is hampered by several major threats, among them confounding and attrition bias bias (patients who stop treatment no longer contribute information, which may overestimate true drug effectiveness).Objectives:To present points to consider (PtC) when analysing and reporting comparative effectiveness with observational data in rheumatology (EULAR-funded taskforce).Methods:The task force comprises 18 experts: epidemiologists, statisticians, rheumatologists, patients, and health professionals.Results:A systematic literature review of methods currently used for comparative effectiveness research in rheumatology and a statistical simulation study were used to inform the PtC (table). Overarching principles focused on defining treatment effectiveness and promoting robust and transparent epidemiological and statistical methods increase the trustworthiness of the results.Points to considerReporting of comparative effectiveness observational studies must follow the STROBE guidelinesAuthors should prepare a statistical analysis plan in advanceTo provide a more complete picture of effectiveness, several outcomes across multiple health domains should be comparedLost to follow-up from the study sample must be reported by the exposure of interestThe proportion of patients who stop and/or change therapy over time, as well as the reasons for treatment discontinuation must be reportedCovariates should be chosen based on subject matter knowledge and model selection should be justifiedThe study baseline should be at treatment initiation and a description of how covariate measurements relate to baseline should be includedThe analysis should be based on all patients starting a treatment and not limited to patients remaining on treatment at a certain time pointWhen treatment discontinuation occurs before the time of outcome assessment, this attrition should be taken into account in the analysis.Sensitivity analyses should be undertaken to explore the influence of assumptions related to missingness, particularly in case of attritionConclusion:The increased use of real-world comparative effectiveness studies makes it imperative to reduce divergent or contradictory results due to biases. Having clear recommendations for the analysis and reporting of these studies should promote agreement of observational studies, and improve studies’ trustworthiness, which may also facilitate meta-analysis of observational data.Disclosure of Interests:Delphine Courvoisier: None declared, Kim Lauper: None declared, Sytske Anne Bergstra: None declared, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Thomas Frisell: None declared, Kimme Hyrich Grant/research support from: Pfizer, UCB, BMS, Speakers bureau: Abbvie, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Joanna KEDRA: None declared, Pedro M Machado Consultant of: PMM: Abbvie, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Speakers bureau: PMM: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Maria Jose Santos Speakers bureau: Novartis and Pfizer, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Simon Stones Consultant of: I have been a paid consultant for Envision Pharma Group and Parexel. This does not relate to this abstract., Speakers bureau: I have been a paid speaker for Actelion and Janssen. These do not relate to this abstract., Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Axel Finckh Grant/research support from: Pfizer: Unrestricted research grant, Eli-Lilly: Unrestricted research grant, Consultant of: Sanofi, AB2BIO, Abbvie, Pfizer, MSD, Speakers bureau: Sanofi, Pfizer, Roche, Thermo Fisher Scientific
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Tse, K., Y. Peña, K. Arntsen, et al. "AB1338-HPR GLOBAL PATIENT PERSPECTIVE ON TOP CHALLENGES IN LUPUS CARE AND RESEARCH PARTICIPATION." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1957.1–1957. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2871.
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Background:The Addressing Lupus Pillars for Health Advancement (ALPHA) Project is a global consensus initiative to identify, prioritize and address top barriers in lupus drug development, clinical care and access to care. The Lupus Foundation of America convenes ALPHA with Tufts Center for the Study of Drug Development and a Global Advisory Committee of lupus experts representing clinician-scientists, industry and patients.Objectives:Collect global patient input to determine alignment with the lupus clinician-scientist community on prior published consensus of top lupus barriers.Methods:A 23-question online Qualtrics survey was developed to identify challenges across lupus diagnosis, clinical care and research participation. The survey, available in English, Spanish, Korean and simplified Chinese, was fielded in November 2019 to people with lupus and caregivers of children <18 with lupus. SPSS 26 and SAS 9.4 were used for descriptive statistics and sub-analysis.Results:Analysis included only consented responses with ≥ 68% survey completion (n=3,447) received across 83 countries. 95% were female with a mean age of 45. Respondents reported being White (57%), Black or of African descent (14%), Hispanic or Latino (18%) and Asian (10%). 65% resided in the US while 35% resided in countries outside of the US. 97% were people with lupus while 3% were caregivers to children <18 with lupus.Highest ranked challenges were similar globally and across children and adults: medication side effects, lack of treatment options and high out-of-pocket costs. Managing side effects ranked significantly higher (p<.05) outside of the US (48%) compared to US (40%). 50% of caregivers reported managing side effects as the top challenge for children compared to 43% of adults (p<.05). Research participation was low (24%) and lower among children (16%). The top reason for not participating in a clinical trial was not being asked by their doctor.Conclusion:This global survey revealed that medication side effects and lack of effective treatments are top challenges for people with lupus, including children. Most respondents were never asked by their doctors to participate in a clinical trial, which may explain difficulties in trial recruitment. These barriers are consistent with prior published barriers identified by the clinician-scientist community.Acknowledgments:ALPHA sponsors: EMD Serono, GSK, Aurinia, MallinckrodtDisclosure of Interests:Karin Tse: None declared, Yaritza Peña: None declared, Kathleen Arntsen: None declared, Sang-Cheol Bae: None declared, Lauren Bloch Consultant of: Faegre Drinker Consulting is a division of Faegre Drinker Biddle & Reath, a law and consulting firm that represents patient advocacy organizations and sponsors developing drugs, Ian N. Bruce Grant/research support from: Genzyme Sanofi, GSK, and UCB, Consultant of: Eli Lilly, AstraZeneca, UCB, Iltoo, and Merck Serono, Speakers bureau: UCB, Karen Costenbader Grant/research support from: Merck, Consultant of: Astra-Zeneca, Bradley Dickerson Employee of: Aurinia, Thomas Dörner Grant/research support from: Janssen, Novartis, Roche, UCB, Consultant of: Abbvie, Celgene, Eli Lilly, Roche, Janssen, EMD, Speakers bureau: Eli Lilly, Roche, Samsung, Janssen, Kenneth Getz: None declared, Amy Kao Employee of: EMD Serono, Susan Manzi: None declared, Eric F. Morand Grant/research support from: AstraZeneca, Consultant of: AstraZeneca, Speakers bureau: AstraZeneca, Sandra Raymond: None declared, Brad H Rovin Grant/research support from: GSK, Consultant of: GSK, Laura Schanberg Grant/research support from: Sobi, BMS, Consultant of: Aurinia, UCB, Sanofi, Victoria Werth Grant/research support from: Biogen, Celgene, Gilead, Janssen, Viela, Consultant of: Biogen, Gilead, Janssen, Abbvie, GSK, Resolve, AstraZeneca, Amgen, Eli Lilly, EMD Serono, BMS, Viela, Kyowa Kirin, Joan Von Feldt Shareholder of: GSK, Employee of: GSK, David Zook Consultant of: Faegre Drinker Consulting is a division of Faegre Drinker Biddle & Reath, a law and consulting firm that represents patient advocacy organizations and sponsors developing drugs, Leslie Hanrahan: None declared
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Highfield, Julie, and Jack Parry-Jones. "Professional Quality of Life in intensive care medicine: The 2018 Faculty of Intensive Care Medicine Workforce survey." Journal of the Intensive Care Society 21, no. 4 (2019): 299–304. http://dx.doi.org/10.1177/1751143719877102.
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Background Critical care is widely perceived, both within and outside of the speciality, as unremitting and emotionally burdensome. There is a perception of a higher risk to medical staff of burnout than other specialities. Critical care also has considerable emotional and professional rewards. We sought to examine this balance between emotional reward and stress in UK critical care consultants registered with the Faculty of Intensive Care Medicine. Method We conducted a Wellbeing survey of the Faculty of Intensive Care Medicine consultant membership utilising the Professional Quality of Life (Pro-QOL) survey tool. The survey was conducted as part of the Annual Workforce Census. Results In sum, 799 members completed the Pro-QOL survey, making this one of the largest surveys of physician wellbeing in critical care medicine. Data were analysed in accordance with the Pro-QOL manual. Conclusions The results demonstrate moderate risk for burnout and secondary traumatic stress, but this is balanced by moderate compassion satisfaction. No association was demonstrated between age, sex, or size of critical care unit worked in. Further follow-up of this consultant group is warranted to better understand risk factors for burnout and for future mitigation of these risk factors whilst also enhancing the positive aspects of working as a consultant in critical care medicine.
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Spiers, H., H. Enayati, R. Moussa, et al. "Augmenting ENT surgery outside the medical school curriculum: the role of a 1-day otolaryngology course." Journal of Laryngology & Otology 133, no. 4 (2019): 269–74. http://dx.doi.org/10.1017/s0022215119000331.
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AbstractBackgroundENT is highly under-represented in the saturated UK medical school curriculum, comprising less than 1 per cent of the curriculum. A 1-day course was implemented in order to raise awareness of ENT among medical students, educate them in the specialty and teach a basic skill.MethodsThe skills day comprised lectures by consultants followed by a consultant-led workshop teaching tracheostomy. Pre- and post-course questionnaires assessed perceptions of ENT, confidence performing tracheostomy and interest in ENT as a career.ResultsPerceptions of ENT as a specialty were improved by up to 80 per cent (p < 0.01). There was improved understanding of and confidence in performing tracheostomies. Interest in a career in ENT was increased by 77 per cent (p < 0.01).ConclusionA 1-day course run by a student body can be a powerful adjunct to the medical school curriculum, in terms of educating undergraduates in ENT and inspiring the pursuit of ENT as a career.
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Lauper, K., J. Kedra, M. De Wit, et al. "OP0198 A SYSTEMATIC REVIEW TO INFORM THE EULAR POINTS TO CONSIDER WHEN ANALYSING AND REPORTING COMPARATIVE EFFECTIVENESS RESEARCH WITH OBSERVATIONAL DATA IN RHEUMATOLOGY." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 123.2–124. http://dx.doi.org/10.1136/annrheumdis-2020-eular.882.
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Background:Comparative effectiveness studies using observational data are increasingly used. Despite their high potential for bias, there are no detailed recommendations on how these studies should best be analysed and reported in rheumatology.Objectives:To conduct a systematic literature review of comparative effectiveness research in rheumatology to inform the EULAR task force developing points to consider when analysing and reporting comparative effectiveness research with observational data.Methods:All original articles comparing drug effectiveness in longitudinal observational studies of ≥100 patients published in key rheumatology journals (Scientific Citation Index > 2) between 1.01.2008 and 25.03.2019 available in Ovid MEDLINE® were included. Titles and abstracts were screened by two reviewers for the first 1000 abstracts and independently checked to ensure sufficient agreement has been reached. The main information extracted included the types of outcomes used to assess effectiveness, and the types of analyses performed, focusing particularly on confounding and attrition.Results:9969 abstracts were screened, with 218 articles proceeding to full-text extraction (Figure 1), representing a number of rheumatic and musculoskeletal diseases. Agreement between the two reviewers for the first 1000 abstracts was 92.7% with a kappa of 0.6. The majority of the studies used several outcomes to evaluate effectiveness (Figure 2A). Most of the studies did not explain how they addressed missing data on the covariates (70%) (Figure 2B). When addressed (30%), 44% used complete case analysis and 10% last observation carried forward (LOCF). 25% of studies did not adjust for confounding factors and there was no clear correlation between the number of factors used to adjust and the number of participants in the studies. An important number of studies selected covariates using bivariate screening and/or stepwise selection. 86% of the studies did not acknowledge attrition (Figure 2C). When trying to correct for attrition (14%), 38% used non-responder (NR) imputation, 24% used LUNDEX1, a form of NR imputation, and 21% LOCF.Conclusion:Most of studies used multiple outcomes. However, the vast majority did not acknowledge missing data and attrition, and a quarter did not adjust for any confounding factors. Moreover, when attempting to account for attrition, several studies used methods which potentially increase bias (LOCF, complete case analysis, bivariate screening…). This systematic review confirms the need for the development of recommendations for the assessment and reporting of comparative drug effectiveness in observational data in rheumatology.References:[1]Kristensen et al. A&R. 2006 Feb;54(2):600-6.Acknowledgments:Support of the Standing Committee on Epidemiology and Health Services ResearchDisclosure of Interests:Kim Lauper: None declared, Joanna KEDRA: None declared, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Bruno Fautrel Grant/research support from: AbbVie, Lilly, MSD, Pfizer, Consultant of: AbbVie, Biogen, BMS, Boehringer Ingelheim, Celgene, Lilly, Janssen, Medac MSD France, Nordic Pharma, Novartis, Pfizer, Roche, Sanofi Aventis, SOBI and UCB, Thomas Frisell: None declared, Kimme Hyrich Grant/research support from: Pfizer, UCB, BMS, Speakers bureau: Abbvie, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Pedro M Machado Consultant of: PMM: Abbvie, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Speakers bureau: PMM: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Maria Jose Santos Speakers bureau: Novartis and Pfizer, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Simon Stones Consultant of: I have been a paid consultant for Envision Pharma Group and Parexel. This does not relate to this abstract., Speakers bureau: I have been a paid speaker for Actelion and Janssen. These do not relate to this abstract., Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Robert B.M. Landewé Consultant of: AbbVie; AstraZeneca; Bristol-Myers Squibb; Eli Lilly & Co.; Galapagos NV; Novartis; Pfizer; UCB Pharma, Axel Finckh Grant/research support from: Pfizer: Unrestricted research grant, Eli-Lilly: Unrestricted research grant, Consultant of: Sanofi, AB2BIO, Abbvie, Pfizer, MSD, Speakers bureau: Sanofi, Pfizer, Roche, Thermo Fisher Scientific, Sytske Anne Bergstra: None declared, Delphine Courvoisier: None declared
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von Platen, Sara. "The communication consultant: an important translator for communication management." Journal of Communication Management 19, no. 2 (2015): 150–66. http://dx.doi.org/10.1108/jcom-06-2013-0049.
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Purpose – The purpose of this paper is to put forward a theoretical model which conceptualizes and clarifies the function and skills of communication consultants in terms of translation. Design/methodology/approach – The paper combines theoretical underpinnings from Scandinavian institutional theory with empirical examples from an interview study with ten senior communication managers in Swedish public sector organizations. Findings – Communication consultants are explained to perform varying translator functions ranging from a neutral transcoder to a freely interpretive translator and sensegiver. These functions are enacted as the consultant span organizational boundaries and contexts inside and outside the organization. The consultants are apt to carry out these tasks due to their translator expertise which resides in, e.g. multicontextual knowledge and bilingual skills, something which their clients lack. Research limitations/implications – The scope of the empirical material is limited to public organizations and a Swedish setting, and may therefore not be valid in other cultural contexts. Practical implications – The model highlights the intersecting work of communication consultants and their clients and thus raises questions concerning the legitimacy and core responsibilities of communication managers. The paper also argues that managers and consultants need to develop their translator skills, and that higher education in communication and PR should prepare students for professions where translator skills may be of great importance. Originality/value – The functions and tasks of communication consultants is a neglected area in communication research. By providing a comprehensive and pragmatic framework for communication consultants work as translation, the present research adds knowledge about the essential functions these actors perform and how they contribute to communication management as well as to organizational performance.
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Vaughan, Phillip J. "The supervision register: one year on." Psychiatric Bulletin 20, no. 3 (1996): 143–45. http://dx.doi.org/10.1192/pb.20.3.143.
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A postal survey was conducted within four regional Health Authorities to ascertain how widely the supervision register had been applied in its first year of operation in adult mental health. A 72% response rate was achieved. The results showed that the register has been absorbed organisationally but is less accepted professionally. One hundred and nineteen of the 367 consultants in the sample (32%) had no entries on the register at 31st March 1995. The provision of training on its use had a significant effect on compliance, although London-based services had marginally less registrations per consultant than their colleagues elsewhere. Very few outside agencies had required access to the register.
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Moran, Michael G. "Frank Aydelotte: AT&T's First Writing Consultant, 1917–1918." Journal of Technical Writing and Communication 25, no. 3 (1995): 231–41. http://dx.doi.org/10.2190/k5ug-n9p7-3ktf-qlu5.
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In 1917 Frank Aydelotte, an English professor at MIT, became AT&T's first outside writing consultant. Because many of its older, better-educated male employees had been mobilized to fight World War I, the company found itself with numerous young, poorly-educated employees. Drawing on the humanistic approach to writing instruction that he had developed at MIT in his book English and Engineering, Aydelotte created a year-long program at AT&T that taught employees to think and write about issues important to their work. The course is important for two reasons: first, it offers insight into the kinds of early consulting work that English professors did, and, second, it shows that Aydelotte's humanistic approach to technical communication worked as well in business as it did in academic settings.
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Masieh, D., J. Begum, J. Fourmy, and M. K. Nisar. "POS1488-HPR CAN A SPECIALIST NURSE LEAD A COMPREHENSIVE OSTEOPOROSIS SERVICE WITH REMOTE SUPERVISION – AN INNOVATIVE CONCEPT." Annals of the Rheumatic Diseases 80, Suppl 1 (2021): 1028.2–1029. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1069.
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Background:Specialist services traditionally rely on a consultant to lead a multidisciplinary team and provide patient facing activities. However, demand outstrips the limited expertise available and therefore significant delays occur in treatment pathways. There is an urgent need to expand the skill set of the employed workforce and think ‘outside the box’. A service run by clinical nurse specialists (CNS) can be an effective solution. CNS are already an integral part of multidisciplinary teams caring for a diverse range of patients including those with chronic conditions such as osteoporosis.Objectives:We designed an innovative osteoporosis service with patients consulting only a metabolic bone CNS with a consultant rheumatologist providing remote oversight. The aim of the project was to improve the efficiency of the service by eliminating consultant appointments and reducing unnecessary hospital visits while continuing to deliver a high-quality and safe service.Methods:A new pathway was implemented where a consultant rheumatologist and a CNS virtually triaged post menopausal women over the age of 65 into the service. A dedicated proforma provided the template for the CNS to undertake new patient telephone consultation. Relevant investigations were requested during the telephone clinic and treatment related information was despatched to help with shared decision making. All patients were then reviewed in a Rheumatologist-CNS virtual MDT. An appropriate parenteral treatment option was agreed and confirmed to each individual. The CNS worked through a safety checklist and provided further advice and support to the patient as necessary. Using the database, we compared the timelines for the patient journey to the conventional pathway, obtained the number of consultant follow-up appointments saved by implementing this service, and calculated total savings.Results:In the pilot phase, 116 patients were triaged into the new service. The patient cohort was a combination of new referrals and patients taken from the consultants’ waiting lists. The mean age of the participants was 78 years (65-93). The median time: from referral to virtual triage was 20 days (0-308); from triage to new patient CNS telephone consultation was 20 days (0-137); and from virtual MDT to treatment authorisation was zero days (0-331 days). 45 patients had anabolic therapy commenced via home care. The remainder had anti resorptive therapy. No patient requested face-to-face review. Only one patient fed back that they would’ve preferred to see the consultant once. 116 new patient consultant appointments were saved and the median delay in treatment commencement was reduced from 84 to 38 days.Conclusion:To our knowledge, this is the first successful example of an innovative service wholly provided by CNS for commencing parenteral anti-osteoporotic therapy with only remote consultant supervision. Our service redesign has significantly improved the efficiency of the parenteral osteoporosis pathway with reduction in treatment delay and a more streamlined patient journey. A nurse-delivered osteoporosis treatment pathway is highly effective, safe and provides an innovative solution to address thinly stretched health care resources for people with chronic conditions.Disclosure of Interests:None declared
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Kalela, Jorma. "History Making: The Historian as Consultant." Public History Review 20 (November 27, 2013): 24–41. http://dx.doi.org/10.5130/phrj.v20i0.3631.
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History is not just a genre of knowledge but also a basic feature of human life. Accounting for the past, or creating histories, to quote David Thelen, is ‘as natural a part of life as eating or breathing’. Casual references to what has taken place make up the vast majority of these accounts. But there are also a great number of deliberately created expositions of the past. They are produced in every field of society and by a wide variety of actors, from private persons to, for example, politicians and various media. The totality of them can be called everyday history. These accounts of the past serve present purposes – histories have innumerable functions and are of countless types. Divergent accounts also influence each other, and my suggestion is that their interaction be called the never-ending social process of history-making. History making, in other words, is not the preserve of academically-trained historians. They are experts but not outside observers. Scholarly historians are inescapably involved in the social process of history making. Their work goes beyond prevailing histories: they seek interpretations that make better sense of the past than the existing ones. Embedded in this effort is another constructivist function: they demonstrate ways to think about the past and how to use it. When demonstrating ‘that’s not how it was’, historians at the same display ‘how the presentation should have been constructed’. Even if they don’t think of themselves as consultants on history making they act in this capacity.
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Benbow, Susan Mary, and David Jolley. "One day in the life of old age psychiatrists in the United Kingdom." International Psychogeriatrics 25, no. 6 (2013): 1023–32. http://dx.doi.org/10.1017/s1041610213000331.
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ABSTRACTBackground: The provision of mental health care for older people will become increasingly important with rising demand related to global demographic changes. This project aimed to identify changes in work patterns of UK consultant old age psychiatrists between 1993 and 2012.Method: A link to an online questionnaire was circulated to consultant old age psychiatrists through the Faculty of Old Age Psychiatry, Royal College of Psychiatrists.Results: In all 210 usable responses were received. On the survey day 71% of old age psychiatrists arrived at work before 9 am, and 40% left work after 6 pm. Over one-third (35%) worked for another hour or more at home. The range of activities was broader than previously reported. Administrative activity was undertaken by over 60% and acute ward work by only 26%. Few consultants reported time in long-stay care or day hospitals. Outpatient activity included Memory Clinics and Health Center Clinics. The main stressors reported by consultants were lack of resources and pressures from management-imposed, financially driven service changes. Relationships with people at work (including patients and their families) and outside work were the main identified support.Conclusions: Consultants’ working hours have changed little since 1997, but the range and emphases of activities have changed. Changes in service organization are stressful and consultants are supported by relationships with colleagues and patients. Work patterns are changing in response to demands and constraints on the specialty. Research is needed into service design and work patterns, which can provide humane care in the current economic climate.
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Davies, ML, M. Teli, R. Collins, G. Morris-Stiff, and MH Lewis. "The RCS ESOS Course: What Have We Learned and What Have We to Offer Other Course Organisers?" Bulletin of the Royal College of Surgeons of England 93, no. 8 (2011): 1–5. http://dx.doi.org/10.1308/147363511x587397.
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Previous surgical training provided a long and wide exposure to general surgery but the combination of subspecialisation and reduced training time means that current trainees and consultants are no longer exposed to the same variety and number of surgical cases. Although this may not be a problem in the day-to-day running of a surgical firm, both trainee and consultant surgeons in the emergency setting can feel concerned and stressed by a condition encountered infrequently. Furthermore, with the rapid change in technology, operations are often rapidly superseded and leave surgeons at risk of criticism if they are not 'up to date' in a condition outside their specialty. It is therefore important that trainees and consultants alike keep abreast of advances in the management of a broad range of emergency conditions while continuing to develop their own subspecialty interest.
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Kendall, Nick. "Improving Access to Oral Surgery Services in Primary Care." Primary Dental Care os16, no. 4 (2009): 137–42. http://dx.doi.org/10.1308/135576109789389540.
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This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.
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Lewis, Gerald W. "Managing Crises and Trauma in the Workplace." AAOHN Journal 41, no. 3 (1993): 124–30. http://dx.doi.org/10.1177/216507999304100303.
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Reactions to trauma/crisis in the workplace may have far reaching repercussions on the emotional as well as financial status of an organization. It is imperative to address these issues and situations as they occur. Human resource, employee assistance, and occupational health professionals should: seek out and receive training in the area of managing trauma/crisis in the workplace; take responsibility for formulating policy and procedures with management; promote training programs that cover this topic for the organization; and use resources and other professionals that may have more/other experience in this area. If individuals feel that their training is limited, they may want to contact an outside consultant to conduct the debriefmgs. However, the in-house staff will need to remain active and involved long after the outside consultant has left. Resolution of a crisis/trauma/disaster is not an event, but rather an ongoing process.
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Henderson, J. A., C. J. Simpson, and J. D. Mumford. "The use of car telephones by psychiatrists." Psychiatric Bulletin 16, no. 12 (1992): 756–57. http://dx.doi.org/10.1192/pb.16.12.756.
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As community services develop, medical staff are increasingly spending more time outside the hospital, despite the most severely ill patients still being in hospital. This may lead to junior medical staff and nurses feeling unsupported by the consultant. In addition, as more disturbed patients are kept out of hospital, the general practitioner and community health workers may require to contact the psychiatrist more often to talk about patients or to request urgent assessment. Therefore the importance of communication with consultants is increased both from the hospital and from the community while they are spending increasing amounts of time in their cars. In a discipline where communication is of paramount importance, a failure to meet this growing need would undermine the effectiveness of the service as a whole.
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Lodise, Thomas P., Roger Echols, Weiying Wang, Frank Corvino, and Bin Cai. "1191. Prevalence and Microbiology of Carbapenem Resistance Among Six Gram-Negative Pathogens in Bloodstream Infections in US Hospitals, 2010–2015." Open Forum Infectious Diseases 5, suppl_1 (2018): S360. http://dx.doi.org/10.1093/ofid/ofy210.1024.
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Abstract Background Carbapenem resistance (CR) is a growing threat in hospitals in the United States and worldwide. We evaluated the prevalence and geographic distribution of CR among six most common Gram-negative (GN) bloodstream infection (BSI) pathogens in US hospitals. Methods We analyzed microbiology data in a cohort of adults (≥18 years) hospitalized in 181 US hospitals contributing microbiology data to the Premier Healthcare Database (October 2010–September 2015) with blood cultures positive for six most common GN pathogens (S. maltophilia assumed 100% CR). We report CR prevalence by pathogen, hospital ward (ICU vs. floor), and census region. Results Of the 43,095 GN BSIs included, 1,513 (3.5%) were caused by the six most common CR pathogens (Figure 1). CR was more frequently isolated from patients with an ICU stay (4.7%) vs. those without (2.7%). Nearly 75% (n = 1,100) of CR occurred in nonfermenters (S. maltophilia, P. aeruginosa, and A. baumannii). Among individual organisms, the prevalence of CR—outside of S. maltophilia—was highest among A. baumannii, 35.1%, and lowest among E. coli, 0.2% (Figure 2). Geographically, CR prevalence ranged from highest in the Mountain region (7.1%) to lowest in the West North Central (2.3%) (Figure 3). The maximum CR prevalence occurred in A. baumannii from the East North Central (55.7%), and the minimum in E. coli from the West North Central (0.05%) regions. Conclusion Among six most frequently isolated pathogens in BSI, the overall CR prevalence is 3.5%. The wide variations in prevalence based on organism, location in the hospital, and geography emphasize the clinical importance of knowing local pathogen and resistance patterns in order to optimize empiric treatment. Disclosures A. F. Shorr, Astellas: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. Cidara: Consultant, Consulting fee. Merck & Co.: Consultant and Speaker’s Bureau, Consulting fee, Research support and Speaker honorarium. T. P. Lodise Jr., Motif BioSciences: Board Member, Consulting fee.
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Khoiry, Lukmanul Hakim Al, and Ning Rahayu. "Analisis Sidang Sengketa Pajak oleh Pengadilan Pajak yang Dilaksanakan Diluar Daerah Jakarta Ditinjau dari Azas Ease of Administration." Jurnal Ilmiah Administrasi Publik 006, no. 02 (2020): 288–96. http://dx.doi.org/10.21776/ub.jiap.2020.006.02.16.
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The implementation of the tax dispute trial is regulated by the Law of The Republic of Indonesia No.14/2002 concerning Tax Court article 4 which states that the tax dispute trial conducted by the tax court can be held in Jakarta and other regions if it is deemed necessary. The problem arises when local taxpayers whose tax dispute trials are held outside Jakarta hire a tax consultant from Jakarta, the taxpayer must bear the transportation and accomodation costs of the tax consultant team who come to the region where the trial is held, such as airline tickets, hotels, and other costs during the trial. The tax court institution also bear the travel cost of the official team of tax court judges who will lead the trial, because the judge who leads the trial comes from Jakarta. This study aims to analyze the implementation of tax dispute trial held outside Jakarta in terms of the principle of ease of administration. The results show that in terms of the four ease of administration principles, only the principle of efficiency is not fulfilled. This is due to the high costs incurred by taxpayers and tax courts side to conduct tax dispute trials outside Jakarta.
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Ling, Florence Y. Y., and Wei Wey Khoo. "Improving relationships in project teams in Malaysia." Built Environment Project and Asset Management 6, no. 3 (2016): 284–301. http://dx.doi.org/10.1108/bepam-04-2015-0014.
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Purpose – The purpose of this paper is to investigate relational practices that can improve construction project outcomes in Malaysia. Design/methodology/approach – Based on the literature review, a questionnaire was designed containing 14 relational practices that were identified and grouped under five relational norms. Using a survey questionnaire, data were collected from clients, consultants and contractors in Malaysia’s construction industry. In-depth interviews were conducted to validate the statistical findings. Findings – When contracts are adjustable to address uncertainties, the projects concerned have better cost and quality outcomes. A better schedule outcome is correlated with coordinating and monitoring plans jointly. Open communication and sharing trustworthy project information have been found to produce better client-consultant and consultant-contractor relationships at the end of a project. When parties maintain a social relationship outside of a project, relationships between clients, contractors and consultants also improve significantly. Research limitations/implications – The findings are not easily generalisable due to the relatively small sample size, low response rate and the data being collected from only three regions in Malaysia. Practical implications – Clients need to take the lead in adopting relational practices, as these may give rise to warmer relationships and better project outcomes. Showing too much commitment and flexibility may harm the project schedule because of the frequent changes. Originality/value – This study found that the theory of relational contracting norms applies to Malaysia’s construction industry. The parties do not rely strictly on contract conditions but embrace role integrity, preserve relations and harmony to avoid relational conflict, and achieve their goals through proper means.
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Gigliucci, G., O. De Lucia, A. Fioravanti, et al. "AB0588 “ESORT” ITALIAN SOCIETY OF RHEUMATOLOGY (SIR) REGISTER ON OSTEOARTHRITIS (OA): PRELIMINARY DATA." Annals of the Rheumatic Diseases 80, Suppl 1 (2021): 1331.1–1331. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1001.
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Background:In Italy Osteoarthritis (OA) is a widespread and disabling disease that affects an increasingly large number of patients in the population, representing one of the main causes of morbidity and disability with high socio-economic costs. The etiology of OA is multifactorial, even if the significant association with some modifiable risk factors like mechanical overload and obesity is now well demonstrated. Early diagnosis and treatment strategies in OA could reduce both patient morbidity and associated costs.Objectives:Promoted by the Italian Society of Rheumatology (SIR), The Early Symptomatic OsteoaRThritis (ESORT) registry has the aim to study the natural history of OA from the earliest stages (pre- radiographic) considering risk factors in the progression of the disease, and the influence of therapeutic factors on long-term disease outcomes. The ESORT register aims to describe the socio-demographic and clinical characteristics of patients affected by OA in Italy; evaluates the extent of symptoms, functional damage, comorbidities, the frequency of use of drugs currently indicated in our country, and differences related to clinical subsets according with comorbidities and geographical localization of the patient.Methods:Actually 8 Italian Rheumatology centers are involved in the online data entry data of the SIR registry (developed and validated by SIR Study Center), considering patients affected by OA. In particular, the electronic database collects information about main demographic variables, significant anamnestic elements (risk factors and comorbidities), localization of OA, laboratory data, clinimetric indices with WOMAC / FIHOA / VAS scales, radiographic instrumental data and therapy in act. These data are reported in specific forms in the register with annual reassessment.Results:Currently, 318 patients with OA are included in the “ESORT” registry with an extension of observation up to 48 months, 214 women and 104 men with an average age of 71 years and an average weight of 72 kg. About 14% of patients affected by knee OA show Kellgren and Lawrence radiological stage 0 in presence of painful symptoms at the knees. The most frequent localization of OA is the knee (63%), followed by the hip (41%), hand (36%), spine (34%), and other sites (16%). The Table 1 shows details of some parameters (average age, average weight, intake of NSAIDs, intake of opioids and intake of chondroprotectors) according to the localization of the disease. From the registry data, patients with OA results treated mainly with NSAIDs and chondroprotectors, and patients with knee OA are the most frequently treated with opioid analgesics (44%), less used in other OA locations.Conclusion:The “ESORT” register is a useful tool for epidemiological and clinical information relating to patients with OA and for monitoring the evolution of the disease and the response to therapy.Average age (years)Average weight (kg)Intake of NSAIDs (% of patients)Intake of opioids (% of patients)Intake of chondroprotectors (% of patients)OA hand706774%10%25-31%OA knee747585%44%53-59%OA hip697075%25%24-28%OA spine757576%14%19-28%OA other localization747369%13%15-35%Disclosure of Interests:Gianfranco Gigliucci: None declared., Orazio De Lucia: None declared., Antonella Fioravanti: None declared., Felice Galluccio: None declared., Serena Guiducci: None declared., Antimo Moretti: None declared., Marco Matucci-Cerinic Speakers bureau: Consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: Consulting fees or honorarium from Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Antonella Murgo: None declared., Simone Parisi Speakers bureau: Personal fees (as speaker and/or consultant) from NOVARTIS, BMS, LILLY, UCB, MSD, PFIZER, ABBVIE, BIOGEN, AMGEN, JANSENN CILAG, CHIESI and GRUNENTHAL outside the submitted work;, Consultant of: Personal fees (as speaker and/or consultant) from NOVARTIS, BMS, LILLY, UCB, MSD, PFIZER, ABBVIE, BIOGEN, AMGEN, JANSENN CILAG, CHIESI and GRUNENTHAL outside the submitted work;, Roberta Ramonda: None declared., Sara Tenti: None declared., Enrico Tirri: None declared., Alberto Migliore Speakers bureau: Grants from Abiogen,Lilly,Fidia,Jansen (outside the submitted work), Consultant of: Grants from Abiogen,Lilly,Fidia,Jansen (outside the submitted work), Grant/research support from: Grants from Abiogen,Lilly,Fidia,Jansen (outside the submitted work).
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Snyder-Drummond, Robin, Heather Bingham, and Jessica M. Lang. "Massachusetts Parents’ Experiences With Insurance Coverage for Lactation Consultant Services." Clinical Lactation 8, no. 1 (2017): 10–16. http://dx.doi.org/10.1891/2158-0782.8.1.10.
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The Women’s Preventive Services component of the Affordable Care Act (ACA) requires coverage of “lactation supplies and services” with no out-of-pocket cost to the patient. However, as IBCLCs providing in-home lactation consults, we found that during the first year of the ACA mandate, clients often described disappointment with coverage for home visits and for breastfeeding support in general. To have a more specific picture of women’s experiences, our association conducted an online survey of families in Massachusetts who sought insurance coverage for IBCLC care outside of the hospital since the ACA provisions came into effect. The goal was to identify the barriers that families who need these services commonly dealt with. Barriers reported by survey respondents included confusing and inconsistent information provided by insurance companies about coverage, lack of coverage for the time and place they sought IBCLC services, lack of coverage for IBCLCs at all, and restriction to a network that did not include IBCLC providers. These findings suggest that many women are not yet receiving the benefits of insurance coverage for lactation support and point to specific changes that insurance providers should make to provide adequate coverage as mandated under the ACA.
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Holmemo, Marte D. Q., Monica Rolfsen, and Jonas A. Ingvaldsen. "Lean thinking: outside-in, bottom-up? The paradox of contemporary soft lean and consultant-driven lean implementation." Total Quality Management & Business Excellence 29, no. 1-2 (2016): 148–60. http://dx.doi.org/10.1080/14783363.2016.1171705.
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Crabtree, Robert, Eugene Gomolka, and Vicki Blakney. "Predicting organizational and decision-maker demographic barriers to outside consultant utilization: An extension of the consultation process model." Services Marketing Quarterly 12, no. 2 (1995): 107–25. http://dx.doi.org/10.1080/15332969.1995.9985193.
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Crabtree, Robert G., Eugene G. Gomolka, and Vicki L. Blakney. "Predicting Organizational and Decision-Maker Demographic Barriers to Outside Consultant Utilization: An Extension of the Consultation Process Model." Journal of Professional Services Marketing 12, no. 2 (1995): 107–25. http://dx.doi.org/10.1300/j090v12n02_08.
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Welchman, Sophie-Anne, Denis Wilkins, and Harvey Chant. "Time spent in theatre predicts training opportunities and progression for core surgical trainees." Bulletin of the Royal College of Surgeons of England 94, no. 10 (2012): 352–53. http://dx.doi.org/10.1308/bull.2012.94.10.352.
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Operative skills are the defining attribute of a surgeon. Traditional surgical training encourages trainees to take every opportunity to spend time observing and assisting in the operating theatre. There is an impression that the time constraints of working schedules, the breakdown of the traditional consultant team and the structured approach adopted by the Intercollegiate Surgical Curriculum Programme (ISCP) have discouraged trainees from spending time in the operating theatre outside of explicit training sessions.
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Rutherford, Janice Williams, and Steven E. Shay. "Peopling the Age of Elegance: Reinterpreting Spokane's Campbell House--A Collaboration." Public Historian 26, no. 3 (2004): 27–48. http://dx.doi.org/10.1525/tph.2004.26.3.27.
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In the spring of 2001, Janice Williams Rutherford's graduate public history seminar, "Interpreting History through Material Culture" at Washington State University joined in a collaborative project with the staff at Campbell House, a historic house museum owned by the Northwest Museum of Arts and Culture in Spokane, Washington, and outside museum consultant Margaret Piatt. The students undertook the research required to draft a new interpretive script for the museum and worked with staff and consultant to identify appropriate objects and suggest interpretive dialogue gleaned from the archival research. Steven E. Shay, one of the students from the seminar, continued working with museum staff after the academic semester ended to refine the script for adults and school children. The project was a successful learning experience in the area of academic/public collaboration. This article explores its successes and its limitations.
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Mulcahy, Mike. "GDC's review of the dental specialist lists." Bulletin of the Royal College of Surgeons of England 88, no. 1 (2006): 31. http://dx.doi.org/10.1308/147363505x86381.
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In January 2004 the education committee of the General Dental Council (GDC) established the Specialist Lists Review Group. In dentistry the concept of a specialist not necessarily becoming a consultant is well established. A whole cadre of specialists exists outside the hospital setting. The entry and exit of training is quality assured by the Faculty of Dental Surgery (FDS), through the requirement to possess MFDS for entry and through various examinations acting as markers of successful completion of training.
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Iannone, F., N. Maruotti, A. Semeraro, et al. "AB0296 EFFECTIVENESS OF CERTOLIZUMAB IN 506 PATIENTS WITH RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS, AND SPONDYLOARTHRITIS FROM THE APULIAN REGISTRY BIOPURE." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1447.2–1447. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5899.
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Background:Little is known about effectiveness of certolizumab (CTZ) in clinical practice, especially in patients with inadequate response to prior biologics.Objectives:To estimate the survival rate of CTZ in RA, PsA or SpA cohorts from the registry BIOPURE. Secondary endpoint was the changes of clinical outcomes from baseline at 6 and 12 months for each disease.Methods:We analyzed longitudinal data of consecutive patients, affected with RA, PsA or SpA starting a treatment with CTZ recorded into the web-based Apulian registry BIOPURE. Demographic and disease related characteristics were collected at baseline, 6 and 12 months. Drug survival was evaluated by Kaplan-Meier life table analysis. Estimates hazard ratios (HRs, 95% confidence intervals (CI)) of drug discontinuation adjusted for patient’s demographics, disease characteristics and prior biologic treatments were computed by Cox-regression models. Differences of DAS28, DAPSA and BASDAI among baseline, 6 and 12 months were estimated by T-test.Results:506 patients were included in this analysis (table 1). Global mean survival time (95% CI) was 58 (52-64) months. Drug survival rate was significantly higher in RA (71.1%) than in PsA (63.5%, p=0.001), while SpA showed 67.5% (Figure 1). Naïve-CTZ patients showed higher survival rates than biologic-inadequate responder (Bio-IR) patients in PsA (naïve 78.4% vs 56.9%, p=0.02), but not in RA (76.9% vs 64.1%, p=0.08), or SpA (73.7% vs 64.8%, p=0.84). The only weak predictor of drug discontinuation was age at baseline for SpA patients (HR 1.04 (95% CI:1.005-1.007) p=0.02) (Figure 1). No baseline covariate, including sex, cDMARDs co-therapy and biologic-naïve status, was found to be associated with CTZ discontinuation for RA and PsA cohorts. A significant improvement of clinical outcomes from baseline was seen at 6 and 12 months, regardless prior biologic therapies. In RA DAS28 dropped from 3.95 ±1.5 to 2.77 ±1.3 at 6 months (p=0.0001) and 2.55 ±1.3 at 12 months (p= 0.0001). In PsA DAPSA decreased from 19.1 ±10 to 10.8 ±8 at 6 months (p=0.0001) and 9.6 ±7 at 12 months (p=0.0001). In SpA DAS28 reduced from 3.66 ±1.4 to 2.85 ±1.3 at 6 months (p=0.0001) and 2.55 ±1.1 at 12 months (p=0.0001). Additionally, in SpA BASDAI dropped from 5.3 ±1.6 to 3.8 ±2.3 at 6 months (p=0.0001) and 2.8 ±1.8 at 12 months (p=0.0001).Conclusion:In real-life settings CTZ has shown a good effectiveness also in Bio-IR patients. Unlike other TNF-inhibitors, the clinical response and the survival rate were also meaningful in RA patients.Table:RA(nr. 180)PsA(nr.189)SpA(nr.137)Age (mean ± SD)54.5 ±1250.6 ±1252.0 ±11Female82.9 %74.6 %56.3 %BMI (mean)25.9 ± 528.4 ± 526.7 ± 5Dis Durat months (mean ± SD)46 ± 14106 ± 8297 ± 92Naive53.9 %32.8 %28.5 %Prior biologics52.9 %75.0 %71.1 %Glucocorticoids55.9 %39.7 %39.4 %DMARDs72.4 %52.4 %43.8 %DAS28 (mean ± SD)4.8 ± 1.53.6 ± 1.23.7 ± 1.3BASDAI (mean ± SD)5.2 ± 2DAPSA (mean ± SD)19.7 ±10HAQ (mean ± SD)1.2 ± 0.71.1 ± 0.61.2 ± 0.7RF/ACPA +72.4 %Disclosure of Interests:Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Nicola Maruotti Speakers bureau: Pfizer, Angelo Semeraro Speakers bureau: Sanofi, Roche, AbbVie, BMS, MSD, Novartis, Romano Bucci Speakers bureau: Pfizer, Sanofi, MSD, BMS, Giorgio Carlino Speakers bureau: Pfizer, Janssen, AbbVie, MSD, BMS., Leonardo Santo Consultant of: AbbVie, MSD, Novartis UCB outside this work, Speakers bureau: AbbVie, MSD, Novartis UCB outside this work, Laura Quarta: None declared, Carmelo Zuccaro Consultant of: MSD, AbbVie, Novartis, Pfizer, Janssen outside this work, Speakers bureau: MSD, AbbVie, Novartis, Pfizer, Janssen outside this work, Giuseppina Santacesaria: None declared, Marco Fornaro: None declared, Francesco Paolo Cantatore: None declared
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Akinkunmi, Akintunde. "A visits programme for forensic senior registrars." Psychiatric Bulletin 21, no. 5 (1997): 280–82. http://dx.doi.org/10.1192/pb.21.5.280.
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As part of the academic programme for senior registrars in forensic psychiatry working in the North Thames Region, a series of visits to outside institutions of special relevance was organised. These visits form part of a larger academic programme which includes consultant tutorials, journal clubs and case conferences. Between May 1995 and October 1996 the author was the senior registrar in charge of organising the programme and this report is intended to share the experiences gained in visiting these other institutions.
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Khan, Murad M. "The NHS International Fellowship Scheme in Psychiatry: robbing the poor to pay the rich?" Psychiatric Bulletin 28, no. 12 (2004): 435–37. http://dx.doi.org/10.1192/pb.28.12.435.
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The NHS International Fellowship Scheme was launched in 2003 to recruit doctors from outside the UK to fill the shortage of doctors in the NHS. While the intended and stated primary purpose was to fill the service needs of the NHS, a secondary purpose appeared to be the opportunity the scheme would offer to overseas doctors to work in a ‘unique health care system’ (Goldberg, 2003). Doctors would be appointed at consultant level in the NHS for a maximum period of 2 years.
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Sparks, J., Z. Wallace, A. Seet, et al. "OP0006 ASSOCIATIONS OF BASELINE USE OF BIOLOGIC OR TARGETED SYNTHETIC DMARDS WITH COVID-19 SEVERITY IN RHEUMATOID ARTHRITIS: RESULTS FROM THE COVID-19 GLOBAL RHEUMATOLOGY ALLIANCE." Annals of the Rheumatic Diseases 80, Suppl 1 (2021): 2.1–4. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1632.
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Background:Targeted DMARDs may dampen the inflammatory response in COVID-19, perhaps leading to a less severe clinical course. However, some DMARD targets may impair viral immune defenses. Due to sample size limitations, previous studies of DMARD use and COVID-19 outcomes have combined several heterogeneous rheumatic diseases and medications, investigating a single outcome (e.g., hospitalization).Objectives:To investigate the associations of baseline use of biologic or targeted synthetic (b/ts) DMARDs with a range of poor COVID-19 outcomes in rheumatoid arthritis (RA).Methods:We analyzed voluntarily reported cases of COVID-19 in patients with rheumatic diseases in the COVID-19 Global Rheumatology Alliance physician registry (March 12, 2020 - January 6, 2021). We investigated RA treated with b/tsDMARD at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAK), interleukin-6 inhibitors (IL6i), or tumor necrosis factor inhibitors (TNFi). The outcome was an ordinal scale (1-4) for COVID-19 severity: 1) no hospitalization, 2) hospitalization without oxygen need, 3) hospitalization with any oxygen need or ventilation, or 4) death. Baseline covariates including age, sex, smoking, obesity, comorbidities (e.g., cardiovascular disease, cancer, interstitial lung disease [ILD]), concomitant non-biologic DMARD use, glucocorticoid use/dose, RA disease activity, country, and calendar time were used to estimate propensity scores (PS) for b/tsDMARD. The primary analysis used PS matching to compare each drug class to TNFi. Ordinal logistic regression estimated ORs for the COVID-19 severity outcome. In a sensitivity analysis, we used traditional multivariable ordinal logistic regression adjusting for covariates without matching.Results:Of the 1,673 patients with RA on b/tsDMARDs at the onset of COVID-19, (mean age 56.7 years, 79.6% female) there were n=154 on ABA, n=224 on RTX, n=306 on JAK, n=180 on IL6i, and n=809 on TNFi. Overall, 498 (34.3%) were hospitalized and 112 (6.7%) died. Among all patients, 353 (25.3%) were ever smokers, 197 (11.8%) were obese, 462 (27.6%) were on glucocorticoids, 1,002 (59.8%) were on concomitant DMARDs, and 299 (21.7%) had moderate/high RA disease activity. RTX users were more likely than TNFi users to have ILD (11.6% vs. 1.7%) and history of cancer (7.1% vs. 2.0%); JAK users were more likely than TNFi users to be obese (17.3% vs. 9.0%). After propensity score matching, RTX was strongly associated with greater odds of having a worse outcome compared to TNFi (OR 3.80, 95% CI 2.47, 5.85; Figure). Among RTX users, 42 (18.8%) died compared to 27 (3.3%) of TNFi users (Table). JAK use was also associated with greater odds of having a worse COVID-19 severity (OR 1.52, 95%CI 1.02, 2.28). ABA or IL6i use were not associated with COVID-19 severity compared to TNFi. Results were similar in the sensitivity analysis and after excluding cancer or ILD.Table 1.Frequencies for the ordinal COVID-19 severity outcome for patients with RA on biologic or targeted synthetic DMARDs (n=1673).COVID-19 outcomes by severity scale (n,%)ABAn=154RTXn=224JAKn=306IL6in=180TNFi n=8091)Not hospitalized113 (73.3%)121 (54.0%)220 (71.9%)150 (83.3%)666 (82.3%)2)Hospitalization without oxygenation10 (6.5%)14 (6.2%)11 (3.6%)9 (5.0%)53 (6.5%)3)Hospitalization with any oxygenation or ventilation16 (10.4%)47 (21.0%)52 (17.0%)16 (8.9%)63 (7.8%)4)Death15 (9.7%)42 (18.8%)23 (7.5%)5 (2.8%)27 (3.3%)Conclusion:In this large global registry of patients with RA and COVID-19, baseline use of RTX or JAK was associated with worse severity of COVID-19 compared to TNFi use. The very elevated odds for poor COVID-19 outcomes in RTX users highlights the urgent need for risk-mitigation strategies, such as the optimal timing of vaccination. The novel association of JAK with poor COVID-19 outcomes requires replication.Acknowledgements:The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the ACR, EULAR, the UK National Health Service, the National Institute for Health Research, the UK Department of Health, or any other organization.Disclosure of Interests:Jeffrey Sparks Consultant of: Bristol-Myers Squibb, Gilead, Inova, Janssen, and Optum, unrelated to this work, Grant/research support from: Amgen and Bristol-Myers Squibb, unrelated to this work, Zachary Wallace Consultant of: Viela Bio and MedPace, outside the submitted work., Grant/research support from: Bristol-Myers Squibb and Principia/Sanofi, Andrea Seet: None declared, Milena Gianfrancesco: None declared, Zara Izadi: None declared, Kimme Hyrich Speakers bureau: Abbvie unrelated to this study, Grant/research support from: BMS, UCB, and Pfizer, all unrelated to this study, Anja Strangfeld Paid instructor for: AbbVie, MSD, Roche, BMS, Pfizer, outside the submitted work, Grant/research support from: grants from a consortium of 13 companies (among them AbbVie, BMS, Celltrion, Fresenius Kabi, Lilly, Mylan, Hexal, MSD, Pfizer, Roche, Samsung, Sanofi-Aventis, and UCB) supporting the German RABBIT register, outside the submitted work, Laure Gossec Consultant of: Abbvie, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sanofi-Aventis, UCB, unrelated to this study, Grant/research support from: Lilly, Mylan, Pfizer, all unrelated to this study, Loreto Carmona: None declared, Elsa Mateus Grant/research support from: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal S.A., MSD, Celgene, Medac, Pharmakern, GAfPA; grants and non-financial support from Pfizer, outside the submitted work, Saskia Lawson-Tovey: None declared, Laura Trupin: None declared, Stephanie Rush: None declared, Gabriela Schmajuk: None declared, Patti Katz: None declared, Lindsay Jacobsohn: None declared, Samar Al Emadi: None declared, Leanna Wise: None declared, Emily Gilbert: None declared, Ali Duarte-Garcia: None declared, Maria Valenzuela-Almada: None declared, Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Philippe Dieudé Consultant of: Boerhinger Ingelheim, Bristol-Myers Squibb, Lilly, Sanofi, Pfizer, Chugai, Roche, Janssen unrelated to this work, Grant/research support from: Bristol-Myers Squibb, Chugaii, Pfizer, unrelated to this work, Elena Nikiphorou: None declared, Vanessa Kronzer: None declared, Namrata Singh: None declared, Manuel F. Ugarte-Gil Grant/research support from: Janssen and Pfizer, Beth Wallace: None declared, Akpabio Akpabio: None declared, Ranjeny Thomas: None declared, Suleman Bhana Consultant of: AbbVie, Horizon, Novartis, and Pfizer (all <$10,000) unrelated to this work, Wendy Costello: None declared, Rebecca Grainger Speakers bureau: Abbvie, Janssen, Novartis, Pfizer, Cornerstones, Jonathan Hausmann Consultant of: Novartis, Sobi, Biogen, all unrelated to this work (<$10,000), Jean Liew Grant/research support from: Yes, I have received research funding from Pfizer outside the submitted work., Emily Sirotich Grant/research support from: Board Member of the Canadian Arthritis Patient Alliance, a patient run, volunteer based organization whose activities are largely supported by independent grants from pharmaceutical companies, Paul Sufka: None declared, Philip Robinson Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Consultant of: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer and UCB (all < $10,000), Pedro Machado Speakers bureau: Yes, I have received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Consultant of: Yes, I have received consulting/speaker’s fees from Abbvie, BMS, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this study (all < $10,000)., Jinoos Yazdany Consultant of: Eli Lilly and AstraZeneca unrelated to this project
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Cornick, Ed. "College pump-primes urological research." Bulletin of the Royal College of Surgeons of England 91, no. 9 (2009): 300–301. http://dx.doi.org/10.1308/147363509x474214.
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Marcus Drake, a consultant surgeon at Bristol Urological Institute (BUI) at Southmead Hospital, believes that undertaking research into surgical problems is increasingly challenging: 'The decline in numbers of medical academics has particularly affected the surgical specialties. "Own account" research has become harder and funding is now directed to researchers with a track record so it is ever harder to get started.' His experiences exemplify the challenges that have to be faced and how it is still possible to overcome them, even outside an academic setting.
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Whitney, Daniel, Daniel Whitney, and Guy Brookes. "Evaluation of a novel consultant psychiatric clinic in general practices and its effects on secondary mental health contact and the general practitioners’ perspectives." BJPsych Open 7, S1 (2021): S59. http://dx.doi.org/10.1192/bjo.2021.202.
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AimsTo assess whether direct access to a 45 minute screen appointment in a Consultant Psychiatric clinic, based in General Practice, affects; the number of contacts patients have with secondary care pre and post being seen; whether the General Practitioner (GP) would have referred to secondary services if the clinic had not been in operation; the GPs’ views on how helpful the clinic was in understanding the patients’ problems and managing the problems outside of secondary care.BackgroundA Consultant Psychiatrist in Leeds offered bespoke 45 minute screening appointment clinics in three sister GP practices, accepting direct referrals from GPs without requiring referrals to the local Community Mental Health Team (CMHT). This model was created to reduce the number of patients moving repeatedly between GP and secondary mental health services as this was leading to patient dissatisfaction and increased GP and CMHT workloads.MethodWe compared the number of mental health contacts (per month), for each of the 57 patients who had been referred to the clinic, in the months pre and post being seen in the clinic. We also asked the involved GPs to complete a brief survey for each patient who had been referred to determine whether, they would otherwise have been referred to the CMHT and whether the clinic has helped with their understanding and management of the patients’ problems.ResultThe mean number of contacts with secondary services before being seen in clinic was 3.30 per month compared to 0.44 after being seen. The mean difference of 2.86 is statistically significant on a paired-test with a P Value of 0.0149 (95% confidence intervals of 0.58 to 5.13). We received 22 survey responses from GPs of patients referred to the clinic including for patients who did not attend. All 22 responses indicated that the patient would have been referred to the CMHT if the clinic had not been available. 95% were rated as being very helpful or moderately helpful in understanding the patient's problems. 91% were rated as very helpful or moderately helpful in managing the patients’ problems outside secondary care.ConclusionOur evaluation has demonstrated that a model of direct access for GPs to a Consultant Psychiatric clinic can reduce referrals and patient contacts with secondary mental health services. GPs have found this model helpful in understanding patients’ problems and managing the problems outside of secondary care.
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Lane, Peter. "Development of an Applicator and A Helicopter Borne Ignition Device Launching System for Using Oil Herders in Remote and Arctic Locations." International Oil Spill Conference Proceedings 2017, no. 1 (2017): 2017052. http://dx.doi.org/10.7901/2169-3358-2017.1.000052.
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Desmi Ro-Clean have been involved in the development and commercialization of “OIL HERDER” chemicals since the re-emergence of interest in this technology by the oil industry in about 2008. We commercialized two products under a grant from Exxon Mobil Upstream Research Company in 2011. Since the acceptance of the two products on the USEPA schedule in June of 2012, we have been involved in the development of a commercially practical applicator and most recently, an integrated ignitor system which can be operated from a single helicopter. This latter activity has been sponsored by the International Oil and Gas Producers Association (IOGP) Joint Industry Project (JIP) Meso scale testing of the herder and Igniter methods was tested at Poker Flats near Fairbanks Alaska in a JIP funded project conducted in association with SL Ross Environmental Consultants Ltd. The purpose of this poster session is to highlight the activities and track the progress of the project from inception to current status. We are presently involved in the integration project which will be nearly completed by June 30, 2016, so this poster session will be timely to the International Oil Spill Conference. Development and presentation of the poster session will be conducted by Peter Lane, currently a contractor and consultant to DESMI Ro-Clean whose sole responsibility within the corporation is to continue the ongoing task of commercialization of herders and associated accessories. Peter Lane has over 46 years of experience in the Oil Spill Industry. While semi-retired, Lane has continued working in the OSR field as a consultant to other companies outside of DESMI Ro-Clean.
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Deva, M. Parameshvara. "Mental health reform in Fiji and opportunities for training assistance." International Psychiatry 11, no. 2 (2014): 36–38. http://dx.doi.org/10.1192/s1749367600004343.
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Fiji inherited a British colonial healthcare system. In 2010 the long dormant mental health law was replaced by the Mental Health Decree (MHD), which set up divisional mental health units for the purpose of managing mental health problems outside of the old asylum. The Ministry of Health recruited an overseas consultant to help improve training. Under the MHD, stress management wards, stress management clinics and stress management day centres have been set up, to decentralise and deinstitutionalise psychiatric care. These are on the whole doing reasonably well and have good client acceptance.
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Smith, Ronald E., and Jim Johnson. "An Organizational Empowerment Approach to Consultation in Professional Baseball." Sport Psychologist 4, no. 4 (1990): 347–57. http://dx.doi.org/10.1123/tsp.4.4.347.
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This article describes a psychological skills training program developed for the Houston Astros’ minor league player development program. It represents a mode of consultation that includes the training and supervising of an appropriate professional within the organization who delivers the actual training to the athletes. The goal is to provide a quality and continuity of services that would be difficult to accomplish using the traditional outside consultant model. Issues and problems that arose in the implementation of the program are discussed, and data derived from an evaluation of the program are presented.
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Walton, MJ, JC Walton, M. Bell, and BE Scammell. "The Effectiveness of Physiotherapist-Led Arthroplasty Follow-Up Clinics." Annals of The Royal College of Surgeons of England 90, no. 2 (2008): 117–19. http://dx.doi.org/10.1308/003588408x261528.
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INTRODUCTION The conventional job descriptions of professionals within the NHS need to evolve in order to meet increasingly stringent targets and demands. One innovation is the introduction of a physiotherapist-led arthroplasty follow-up clinic. We present an audit of 1000 appointments to this clinic. PATIENTS AND METHODS A total of 865 patients were seen with 933 arthroplasties over an 8-month period; 135 appointments were not attended. Prospective data were collected at each attendance. RESULTS Less than 7.5% of patients required re-referral to an orthopaedic consultant, of which 36% were for consideration for further joint replacement. The cost of a physiotherapy appointment was £4.97 compared to £5.04 for a traditional orthopaedic assessment. By reducing the number of follow-up patients seen in orthopaedic clinics, we estimate that each consultant would be able to see two additional new patients per week. CONCLUSIONS Assessment of arthroplasty follow-up outside of the traditional orthopaedic clinic setting is a time-effective alternative; however, the cost-benefit and educational impact is less clear.
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Levis, Brooke, Andrea Benedetti, Kira E. Riehm, et al. "Probability of major depression diagnostic classification using semi-structured versus fully structured diagnostic interviews." British Journal of Psychiatry 212, no. 6 (2018): 377–85. http://dx.doi.org/10.1192/bjp.2018.54.
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BackgroundDifferent diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.AimsTo evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.MethodData collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.ResultsA total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).ConclusionsThe MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.Declaration of interestDrs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
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Becker-Dreps, Sylvia, Bryan Blette, Rafaela Briceno, et al. "Changes in Pneumonia Incidence and Infant Mortality 5 Years Following Introduction of the 13-valent Pneumococcal Conjugate Vaccine in a “3+0” Schedule in Nicaragua." Open Forum Infectious Diseases 4, suppl_1 (2017): S67—S68. http://dx.doi.org/10.1093/ofid/ofx162.161.
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Abstract Background Streptococcus pneumoniae causes an estimated 826,000 deaths of children in the world each year and many health facility visits. To reduce the burden of pneumococcal disease, many nations have added pneumococcal conjugate vaccines to their national immunization schedules. Nicaragua was the first country eligible for funding from the GAVI Alliance to introduce the 13-valent pneumococcal conjugate vaccine (PCV13), provided to infants at 2, 4, and 6 months of age. The goal of this study was to evaluate the population impact of the first five years of the program. Methods Numbers of visits for pneumonia, pneumonia-related deaths, bacterial meningitis, and infant deaths between 2008 and 2015 were collected from all 107 public health facilities in León Department. Vital statistics data provided additional counts of pneumonia-related deaths that occurred outside health facilities. Adjusted incidence rates and incidence rate ratios (IRRa) in the vaccine (2011–2015) and pre-vaccine periods (2008–2010) were estimated using official population estimates as exposure time. Results The IRRa for pneumonia hospitalizations was 0.70 (95% confidence interval [CI]: 0.66, 0.75) for infants, and 0.92 (95% CI: 0.85, 0.99) for one year olds. The IRRa for post-neonatal infant mortality was 0.56 (95% CI: 0.41, 0.77). In the population as a whole, ambulatory visits and hospitalizations for pneumonia, as well as pneumonia-related mortality and rates of bacterial meningitis were lower in the vaccine period. Conclusion Five years following program introduction, reductions were observed in health facility visits for pneumonia in immunized age groups and infant mortality, which would be hard to achieve with any other single public health intervention. Future study is warranted to understand whether the lack of a booster dose (e.g.,, at 12 months) may be responsible for the small reductions in pneumonia hospitalizations observed in one year-olds as compared with infants. Disclosures S. Becker-Dreps, Pfizer: Consultant and Grant Investigator, Consulting fee and Research grant; D. J. Weber, Pfizer: Consultant and Speaker’s Bureau, Consulting fee and Speaker honorarium
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Bakker, M., P. Putrik, J. Rademakers, et al. "OP0257-PARE USING PATIENT HEALTH LITERACY PROFILES TO IDENTIFY SOLUTIONS TO CHALLENGES FACED IN RHEUMATOLOGY CARE." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 162.2–162. http://dx.doi.org/10.1136/annrheumdis-2020-eular.877.
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Background:The prevalence of limited health literacy (i.e. cognitive and social resources of individuals to access, understand and apply health information to promote and maintain good health) in the Netherlands is estimated to be over 36% [1]. Access to and outcomes of rheumatological care may be compromised by limited patient health literacy, yet little is known about how to address this, thus action is required. As influencing individual patients’ health literacy in the rheumatology context is often unrealistic, it is paramount for the health system to be tailored to the health literacy needs of its patients. The OPtimising HEalth LIteracy and Access (Ophelia) process offers a method to inform system change [2].Objectives:Following the Ophelia approach:a. Identify health literacy profiles reflecting strengths and weaknesses of outpatients with RA, SpA and gout.b. Use the health literacy profiles to facilitate discussions on challenges for patients and professionals in rheumatological care and identify possible solutions the health system could offer to address these challenges.Methods:Patients with RA, SpA and gout attending outpatient clinics in three centres in the Netherlands completed the Health Literacy Questionnaire (HLQ) and questions on socio-demographic and health-related characteristics. Hierarchical cluster analysis using Ward’s method identified clusters based on the nine HLQ domains. Three researchers jointly examined 24 cluster solutions for meaningfulness by interpreting HLQ domain scores and patient characteristics. Meaningful clusters were translated into health literacy profiles using HLQ patterns and demographic data. A patient research partner confirmed the identified profiles. Patient vignettes were designed by combining cluster analyses results with qualitative patient interviews. The vignettes were used in two two-hour co-design workshops with rheumatologists and nurses to discuss their perspective on health literacy-related challenges for patients and professionals, and generate ideas on how to address these challenges.Results:In total, 895 patients participated: 49% female, mean age 61 years (±13.0), 25% lived alone, 18% had a migrant background, 6.6% did not speak Dutch at home and 51% had low levels of education. Figure 1 shows a heat map of identified health literacy profiles, displaying the score distribution per profile across nine health literacy domains. Figure 2 shows an excerpt of a patient vignette, describing challenges for a patient with profile number 9. The workshops were attended by 7 and 14 nurses and rheumatologists. Proposed solutions included health literacy communication training for professionals, developing and improving (visual) patient information materials, peer support for patients through patient associations or group consultations, a clear referral system for patients who need additional guidance by a nurse, social worker, lifestyle coach, pharmacist or family doctor, and more time with rheumatology nurses for target populations. Moreover, several system adaptations to the clinic, such as a central desk for all patient appointments, were proposed.Conclusion:This study identified several distinct health literacy profiles of patients with rheumatic conditions. Engaging with health professionals in co-design workshops led to numerous bottom-up ideas to improve care. Next steps include co-design workshops with patients, followed by prioritising and testing proposed interventions.References:[1]Heijmans M. et al. Health Literacy in the Netherlands. Utrecht: Nivel 2018[2]Batterham R. et al. BMC Public Health 2014, 14:694Disclosure of Interests:Mark Bakker: None declared, Polina Putrik: None declared, Jany Rademakers Speakers bureau: In March 2017, Prof. Dr. Rademakers was invited to speak about health literacy at the “Heuvellanddagen” Conference, hosted by Janssen-Cilag., Mart van de Laar Consultant of: Sanofi Genzyme, Speakers bureau: Sanofi Genzyme, Harald Vonkeman: None declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Hanneke Voorneveld: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Richard Osborne Consultant of: Prof. Osborne is a paid consultant for pharma in the field of influenza and related infectious diseases., Roy Batterham: None declared, Rachelle Buchbinder: None declared, Annelies Boonen Grant/research support from: AbbVie, Consultant of: Galapagos, Lilly (all paid to the department)
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Berry, MG. "An aesthetic fellowship: experience from the 'other side'." Bulletin of the Royal College of Surgeons of England 90, no. 3 (2008): 90–91. http://dx.doi.org/10.1308/147363508x285008.
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Gaining aesthetic plastic surgery experience as a trainee working in the NHS is not easy. Operating on patients for non-pathological conditions is an alien concept to the majority of surgeons working outside this field. This report gives some insight into the world of aesthetic surgery and offers some advice to trainees seeking aesthetic operative experience before becoming a consultant surgeon. Although I was due for the aesthetic rotation in the final year of my deanery's training scheme, I missed out on it. Feeling that this was unfair both on me and on future patients, I looked around for an alternative. A personal recommendation many years earlier led me to the post offered by the Institute of Cosmetic and Reconstructive Surgery (ICRS) in London. Like many of my colleagues, my experience until that point had been of the occasional afternoon or weekend reverting to the retractorholding and suture-cutting status of the neophyte surgeon, which followed a summons from the consultant surgeon, with the furtive handing over of an envelope at the end of the list. The selection of patients for procedures and how they appeared post-operatively remained mysteries.
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Bowker, Lynne, and César Villamizar. "Embedding a records manager as a strategy for helping to positively influence an organization’s records management culture." Records Management Journal 27, no. 1 (2017): 57–68. http://dx.doi.org/10.1108/rmj-02-2016-0005.
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Purpose This paper aims to explore the benefits of embedding a records manager into a team of university administrators to help them address their information management needs. Design/methodology/approach The paper describes an experience that was inspired by reports of successful experiences with embedded librarianship. The literature on records management culture and embedded librarianship is reviewed to identify best practices and criteria for success. These criteria are used to design and implement a pilot project where, rather than hiring a consultant, a records manager is embedded into a quality assurance team working at a large university in Canada. Findings The project is a success in conventional terms (e.g. active files reduced; duplicates deleted; inactive files archived; naming conventions, version control and access rights applied); however, similar results could have been achieved using a consultant. More interesting are the added benefits achieved through embedding. Added benefits included identifying workflow inefficiencies, identifying terminological inconsistencies, iterative training opportunities and useful knowledge sharing outside the project’s scope. The argument is made that an embedded information professional is better able to appreciate the organizational culture, which in turn facilitates the establishment of trusted relationships and produces an overall added value for the entire team. Originality/value There is very little, if any, current literature that explores the value of embedding a records manager into a team, rather than simply hiring a consultant to address information management needs. The outcome of this pilot project will benefit those who are seeking to develop a model for embedding an information professional into their organization to gain an added value.
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Popkova, Tereza, Katarina Hradska, Jana Mihalyova, et al. "Towards Higher Safety of Haemato-Oncological Patients Undergoing Treatment." Blood 134, Supplement_1 (2019): 4757. http://dx.doi.org/10.1182/blood-2019-127011.
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Introduction: Medical care has recently been moving from wards to outpatient clinics due to a growing number of patients, convenient therapeutic approaches and rising emphasis on quality of life. There is an increased need for intensive monitoring of haemato-oncological patients undergoing long-lasting treatment especially when serious infectious complications are expected. Telemedicine is a great tool to keep an eye on patients spending most of their treatment at home, where reaction time plays an important role in reducing the impact of severe adverse events. Methods: We plan on enrolling 100 haemato-oncological patients undergoing treatment who are at high risk of febrile neutropenia and/or sepsis. In the comfort of their homes, selected patients will measure their body temperature, blood pressure and pulse regularly every morning, plus whenever they feel unwell. Contactless measuring is provided by a digital blood pressure monitor and an infrared thermometer. Both devices communicate via bluetooth with a mobile HUB (cell phone), which then encrypts the information and forwards it to the National Monitoring Center. Physicians have real-time access to the measured values through a web portal using any device with an internet connection. Importantly, values registered outside the individually set-up range are immediately sent by SMS to a designated physician, who can then promptly react. Results: In our pilot project, we enrolled 21 patients (33-80 y; median 60 y) including 9 treated for acute leukemia, 5 for multiple myeloma, 4 for chronic lymphocytic leukemia, 1 for myelodysplastic syndrome, 1 for malignant lymphoma and 1 for aplastic anemia. The median duration of monitoring was 6 months (1-16). One thousand, six hundred and twenty-three critical values of systolic (<90-95 mmHg) and diastolic (<50-60 mmHg, >91 mmHg) blood pressure in 19 patients were registered. High blood pressure in patients with inadequate antihypertensive therapy was the most frequent warning. Forty-four critical values of body temperature (>37.9°C) in 6 patients were registered, two cases with concomitant low blood pressure. After a telephone conversation with a physician, ambulatory care was recommended 12 times. Two cases of febrile neutropenia were detected, with the patients instantly hospitalized without progression into sepsis. Four cases of infectious complications (genital herpes, upper respiratory tract infection) with the need for anti-infective therapy and 6 cases of viral infections with only symptomatic treatment indicated were also addressed. Conclusion: Even in a small cohort of patients we demonstrated that the remote monitoring of body temperature, blood pressure and pulse at home enables the early detection of infections and prompt provision of adequate treatment. An evaluation of the financial savings on medical expenses might also be a useful aspect to revise. Disclosures Hajek: Celgene: Honoraria, Other: Consultant or advisory relationship, Research Funding; AbbVie: Other: Consultant or advisory relationship; Bristol-Myers Squibb: Honoraria, Other: Consultant or advisory relationship, Research Funding; Novartis: Other: Consultant or advisory relationship, Research Funding; PharmaMar: Honoraria, Other: Consultant or advisory relationship; Takeda: Honoraria, Other: Consultant or advisory relationship, Research Funding; Janssen: Honoraria, Other: Consultant or advisory relationship, Research Funding; Amgen: Honoraria, Other: Consultant or advisory relationship, Research Funding.
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Whitaker, Leighton C., and Arthur J. Deikman. "The Empathic Ward: Reality and Resistance in Mental Health Reform." Ethical Human Psychology and Psychiatry 11, no. 1 (2009): 50–62. http://dx.doi.org/10.1891/1559-4343.11.1.50.
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This article provides perspective on our experiment to change a psychiatric hospital ward from reliance on drug therapy to psychological treatment. Resistances to the change took many forms, including delaying publication of the results for nearly a decade. Although successful, the treatment program itself was never adopted. The work did have a major impact on the “right to refuse treatment” case originally titled Rogers v. Okin (1979), which barred forced medication and involuntary seclusion except in certain emergencies if an outside consultant agreed. Two publications (Deikman & Whitaker, 1979; Whitaker & Deikman, 1980) described much of the program and its vicissitudes but did not include some of the more resisted features reported in this article.
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Brown ARICS, Richard. "Repair and upgrading of ′The Milliners′, Kent." Structural Survey 11, no. 2 (1993): 135–41. http://dx.doi.org/10.1108/02630809310028495.
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Outlines the work undertaken to repair and upgrade ′The Milliners′, a 16th century structure and Grade II listed building. Discusses the initial thorough investigation of the house, and the methods by which the owner′s brief to retain the character of the house while allowing for a high standard of modern services, was carried out. Details the problems of inserting services into the structure without cutting into the floor and the installation of central heating radiators into the outside wall of one of the bedrooms. Explores the work of the building contractor, electrical services contractor and mechanical services contractor, supervised by a clerk of works. Suggests that the work would have been more efficiently carried out by a single consultant.
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Aitken, Peter, David Perahia, and Padraig Wright. "Psychiatrists entering the pharmaceutical industry in the UK." Psychiatric Bulletin 27, no. 07 (2003): 248–50. http://dx.doi.org/10.1017/s0955603600002518.
Full textAbstract:
As a junior doctor, it can be extremely difficult to imagine a working life outside the NHS. Appointment to a consultant post brings some opportunity to practise medicine outside the NHS, but few contemplate a move to an entirely commercial setting. Those of us who have moved to work entirely in a commercial setting, as pharmaceutical physicians, tend to be regarded with a mixture of curiosity and suspicion by our peers and colleagues, who often reveal a great number of misconceptions about our roles and responsibilities. Yet, currently some 731 physicians are registered with the British Association of Pharmaceutical Physicians, with 25 recording psychiatry or neuroscience as their area of expertise. There are 1400 physicians registered on the mailing list for the Faculty of Pharmaceutical Physicians. It was through reflecting on the level of interest as to our motives and rewards that we were moved to write this article. To colleagues in the NHS, it can seem as if we have moved into an unknown and suspect world. This article aims to describe something of the role of the pharmaceutical physician and the initial experience of moving into the industry.
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Aitken, Peter, David Perahia, and Padraig Wright. "Psychiatrists entering the pharmaceutical industry in the UK." Psychiatric Bulletin 27, no. 7 (2003): 248–50. http://dx.doi.org/10.1192/pb.27.7.248.
Full textAbstract:
As a junior doctor, it can be extremely difficult to imagine a working life outside the NHS. Appointment to a consultant post brings some opportunity to practise medicine outside the NHS, but few contemplate a move to an entirely commercial setting. Those of us who have moved to work entirely in a commercial setting, as pharmaceutical physicians, tend to be regarded with a mixture of curiosity and suspicion by our peers and colleagues, who often reveal a great number of misconceptions about our roles and responsibilities. Yet, currently some 731 physicians are registered with the British Association of Pharmaceutical Physicians, with 25 recording psychiatry or neuroscience as their area of expertise. There are 1400 physicians registered on the mailing list for the Faculty of Pharmaceutical Physicians. It was through reflecting on the level of interest as to our motives and rewards that we were moved to write this article. To colleagues in the NHS, it can seem as if we have moved into an unknown and suspect world. This article aims to describe something of the role of the pharmaceutical physician and the initial experience of moving into the industry.
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Kellerhals, S., J. Amsler, H. Schulze-Koops, et al. "AB0270 EFFECTIVENESS OF A SWITCH FROM TOFACITINIB TO BARICITINIB IN RHEUMATOID ARTHRITIS: A RETROSPECTIVE ANALYSIS OF REAL-WORLD DATA IN SWITZERLAND." Annals of the Rheumatic Diseases 80, Suppl 1 (2021): 1161. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2872.
Full textAbstract:
Background:Janus Kinase Inhibitors (JAKi) have recently been approved for the treatment of rheumatoid arthritis (RA) over the last years. JAKi differ in their specificity for the different JAK family members (JAK1, JAK2, JAK3 and TYK2). All three JAKis that are currently approved in Switzerland seem to have comparable efficacy on different disease stages of RA. Whether a JAKi can be effective after discontinuation of another JAKi is one of the open questions of interest according to the EULAR RA guidelines [1].Objectives:To study the effectiveness of baricitinib in patients with RA after discontinuation of tofacitinib.Methods:Longitudinal, retrospective chart review conducted between October 2019 and December 2020 of patients with RA at two Swiss centers (Kantonsspital Aarau and Inselspital Bern). Disease activity was assessed by DAS 28.Results:12 patients (1 male, 11 female) were treated with 4mg baricitinib/d after tofacitinib was discontinued. Mean age of the patients was 61 years, disease duration 140 months. Patients were previously treated with at least two conventional synthetic DMARDs and 75% with at least one biological DMARD. 58% of patients were positive for ACPA, 42% for rheumatoid factor. 50% of the patients suffered from erosive disease. Tofacitinib was stopped in 92% of the patients because of an insufficient response after a mean of 25.8 months. Moderate EULAR response was achieved in 83.3% of the patients after an average of 8 months treatment with baricitinib, and good EULAR response in 58.3% after an average of 10 months. There were no serious adverse events, neoplasms, opportunistic or serious infections during follow-up.Conclusion:The first retrospective analysis of real-world data of baricitinib following tofacitinib shows that there is a good clinical response in 70% of cases. Although limited by the number of patients this study therefore supports the notion that baricitinib after discontinuation of tofacitinib in RA patients may be an effective therapeutic option.References:[1]Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Annals of the Rheumatic Diseases. 2020;79(6):685-699. doi:10.1136/annrheumdis-2019-216655, p. 695Disclosure of Interests:Simon Kellerhals: None declared, Jennifer Amsler: None declared, Hendrik Schulze-Koops: None declared, Thomas Hügle Consultant of: GSK, Abbvie, Pfizer, Jansen, Novartis, Eli Lilly., Michael J. Nissen Consultant of: Abbvie, Celgene, Eli-Lilly, Janssen, Novartis and Pfizer., Hasler paul Consultant of: Abbvie, Lilly, Diego Kyburz Consultant of: Abbvie, Gilead, Lilly, Novartis and Pfizer, outside of the submitted work, Rudiger Muller Consultant of: Abbvie, Novartis, Grant/research support from: Bebro Pharma