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Jugo, Damir, Ivan Pakozdi, and Zdeslav Milas. "Crisis communication consulting: rethinking the role of PR firms in solving organizational crises." Corporate Communications: An International Journal 25, no. 1 (November 8, 2019): 34–47. http://dx.doi.org/10.1108/ccij-07-2019-0083.
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Purpose The purpose of this paper is to explore the relationship between organizations and their PR firms during crisis situations. It contributes to the field by identifying the role of communication consultants in contemporary organizational crises, tasks they are entrusted by their clients, as well as providing their perspective on current crisis communication practice and its future development. Design/methodology/approach The research is based on 13 semi-structured in-depth interviews with two groups of senior staff in 11 Croatian PR agencies: CEOs, directors, managing partners and senior consultants, all in charge of their clients’ crisis communication projects. Findings The research results suggest that PR firms define crisis differently than their clients, who tend to consider every risk a crisis, which causes a significantly broadened scope of work for their PR firms. The findings also suggest crises to be periods when new PR firm–client relations are often established and caution PR firms to balance between openly expressing their opinion when unfavorable for their clients and providing the best advice possible to achieve a sustainable business model with the clients that they consult. Originality/value This research provides rare insight into crisis communication consulting practice, especially consultant–client relations during crises. Methodologically, it includes a representative group of senior communication practitioners acting as consultants and can provide the management of PR firms and scholars valuable insight into the current and future trends of the crisis communication field in Croatia.
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Middleton, Hugh, Gyles Glover, Steve Onyett, and Karen Linde. "Crisis resolution/home treatment teams, gate-keeping and the role of the consultant psychiatrist." Psychiatric Bulletin 32, no. 10 (October 2008): 378–79. http://dx.doi.org/10.1192/pb.bp.107.018374.
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Aims and MethodThe working relationship between consultant psychiatrists and crisis resolution/home treatment (CRHT) teams varies quite widely. Data from the national survey have been used to investigate the effects of consultant psychiatrist intput upon functions of the CRHT team. Logistic regression was employed to consider the effects of team size, team maturity and consultant input upon gate-keeping and fidelity to model (how many of six criteria teams' activities included).ResultsThere were statistically significant effects of size and maturity upon fidelity, and of maturity and consultant input upon gate-keeping.Clinical ImplicationsThe relationship between the consultant psychiatrist and other elements of the acute care pathway is an important determinant of how it functions. Depending upon how they relate to them, consultants can assist or hinder a team's capacity to fulfill their intended purposes.
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Harrison, Judy, and Barry Traill. "What do consultants think about the development of specialist mental health teams?" Psychiatric Bulletin 28, no. 3 (March 2004): 83–86. http://dx.doi.org/10.1192/pb.28.3.83.
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Aims and MethodThe UK Government is promoting three types of specialist team in psychiatry: assertive outreach, crisis resolution and early intervention in psychosis. Policy guidance suggests that psychiatrists be recruited to work exclusively within these teams, but little is known about the views of psychiatrists regarding their development. A postal survey was undertaken to seek the views of consultant psychiatrists in the North West.ResultsSeventy per cent of psychiatrists responded to the questionnaire. Equal numbers agreed and disagreed with the development of specialist roles. Few services had been able to recruit to extra consultant sessions within the new teams and only a third of consultants believed the resources so far available to be reasonable. Overall views of the new teams were positive (mean scores 6.36, 6.51 and 6.03 on a 1–10 visual analogue scale for assertive outreach, crisis resolution and early onset psychosis teams). Consultants are particularly likely to believe that the new teams will increase patient satisfaction and provide a welcome change in role for some psychiatrists. A total of 64% of consultants believe that crisis resolution services could reduce hospital admissions, compared with 41% for assertive outreach and 31% for early onset psychosis teams. The concern most often voiced was that new services are being developed at the expense of existing teams.Clinical ImplicationsConsultants perceive benefits associated with the new teams but are concerned about their impact on the rest of the organisation. If resource and recruitment issues can be addressed, consultants could prove to be supportive of these new models of service.
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Brockmoeller, Scarlet, Caroline Young, Jessica Lee, Mark J. Arends, Bridget S. Wilkins, Gareth J. Thomas, Karin A. Oien, Louise Jones, and Keith D. Hunter. "Survey of UK histopathology consultants’ attitudes towards academic and molecular pathology." Journal of Clinical Pathology 72, no. 6 (March 25, 2019): 399–405. http://dx.doi.org/10.1136/jclinpath-2018-205568.
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ObjectiveAcademic pathology is facing a crisis; an ongoing decline in academic pathology posts, a paucity of academic pathologist’s in-training and unfilled posts at a time when cellular pathology departments are challenged to deliver increasing numbers of molecular tests. The National Cancer Research Institute initiative in Cellular & Molecular Pathology commissioned a survey to assess attitudes of cellular pathology consultants towards research in order to understand barriers and identify possible solutions to improve this situation. As cellular pathology is encompassing an increasing number of diagnostic molecular tests, we also surveyed the current approach to and extent of training in molecular pathology.MethodsThe survey was distributed to all UK-based consultant pathologists via the Pathological Society of Great Britain & Ireland and Royal College of Pathologist networks. Heads of Department were contacted separately to obtain figures for number of academic training and consultant posts.Results302 cellular pathologists completed the survey which represents approximately 21% of the total cellular histopathology workforce. Most respondents (89%) had been involved in research at some point; currently, 22% were undertaking research formally, and 41% on an informal basis. Of those previously involved in research, 57% stopped early in their consultant career. The majority of substantive academic posts were Professors of which 60% had been in post for >20 years. Most respondents (84%) used molecular pathology in diagnostic work, independent of where they worked or the length of time in post. Notably, 53% of consultants had not received molecular pathology training, particularly more senior consultants and consultants in district general hospitals.ConclusionsThe survey reveals that the academic workforce is skewed towards senior individuals, many of whom are approaching retirement, with a missing cohort of ‘junior consultant’ academic pathologists to replace them. Most pathologists stop formal research activity at the beginning of a consultant career. While molecular pathology is an increasing part of a pathologist’s workload, the majority of consultant cellular pathologists have not received any formal molecular training.
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Adizes, Ichak Kalderon, Dusanka Rodic, and Mladen Cudanov. "Estimating consultant engagement in the corporate lifecycle: study of the bias in South Eastern Europe." Management:Journal of Sustainable Business and Management Solutions in Emerging Economies 22, no. 2 (September 21, 2017): 1. http://dx.doi.org/10.7595/management.fon.2017.0015.
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This paper surveys perception bias regarding the timing of proactive consultant engagement. It aims to improve efficiency and effectiveness of consultant engagement. Research is based on the primary dataset from South Eastern Europe and secondary dataset which is used for comparison as the real lifecycle phase of consultant engagement. Adizes lifecycle model provided our theoretical framework. After data were checked for normality t-test was used for hypotheses confirmation/rejection. T-test confirmed existence of negative bias in early lifecycle phases, onesample t(118) =-16,232, p = 0.000. Significant differences were found for bias of early phases in organisations founded less than 25 years ago (M= -0.301, SD=0.22) and organisations founded more than 25 years ago (M= -0.396, SD=0.24); t(110)= 2.072, p=0.041; also, absolute bias in organisations founded less than 25 years ago(M=1.32, SD=0.27) and organisations founded more than 25 years ago (M=1.20, SD=0.31) is significantly different t(110)= -2.204, p=0.030. Significant differences were not found between early lifecycle stages bias of consultants (M= -0.374, SD=0.26) and users of consulting services (M -0.368, SD=0.22); t(117)= 0.475, p=0.636 but absolute bias in organisations with less than 25 years of chronological age (M=1.32, SD=0.27) and organisations with more than 25 years of chronological age (M=1.20, SD=0.31) is significantly different t(117)=-1.348, p=0.180. This research finds strong bias in estimation of lifecycle phase as time for engagement of proactive consulting services. The timing for consultant engagement is not often correctly estimated by the users of the service, so those services can be engaged as preventive before issues arise in organisation and become crisis at the tip of the organisational iceberg. Main limitations of our research are that we do not have true random sample and that data is from South Eastern Europe which limits wider generalization.
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Rostovskaya, T., I. Groshev, and Yu Krasovskii. "Digital models of the consult-organization of management in the company." Digital Sociology 2, no. 1 (May 31, 2019): 46–54. http://dx.doi.org/10.26425/2658-347x-2019-1-46-54.
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The main segmental areas of activity of a consultant, invited by the head of the company for a fundamental correction of the organization of management in the context of the transition to digital format have been analyzed. The previous experience in management consulting has been rethought for application in modern, digital conditions for improving organizational management. This issue is extremely relevant for the entire consulting community, which is currently experiencing a serious crisis. The article has been addressed, first of all, to colleagues from the National Guild of professional consultants, who are looking for new methodological approaches, developing packages of new consult-competencies and new options for establishing contacts with potential customers. The previous developments have been adapted, namely: visual digital models for clearer visual support of the negotiation processes in business communication with the Customer. In the first digital model a general consulting approach to understanding management in a crisis and post-crisis period of organizing management in the process of mastering digital features of management relations has been introduced. In the second digital model, the positions of transition from a non-digital to digital format have been specified. In the third digital model the meaningful positions of the digital format in management consulting have been demonstrated. In the fourth digital model, the main contradiction in the organization of management has been identified, which must be submitted to the Customer for a final understanding of the situations, that arise. All four digital models are interrelated and help deeply understand the problems of the transition of the company from one state to another. These models “visualize” the negotiation process with the Customer, helping to quickly establish business contacts, as well as significantly reducing the time of the negotiation process.
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Lewis, Gerald W. "Managing Crises and Trauma in the Workplace." AAOHN Journal 41, no. 3 (March 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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Mukherjee, Kamaleeka, Michael Maier, and Simon Wessely. "UK crisis in recruitment into psychiatric training." Psychiatrist 37, no. 6 (June 2013): 210–14. http://dx.doi.org/10.1192/pb.bp.112.040873.
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SummaryPsychiatry recruitment in the UK is in crisis. In this paper we review reasons and solutions for the current predicament, focusing on the UK situation. We assert that there are specific national issues over and above more general and well-established ones, such as stigma and bad-mouthing, which need to be considered. These include factors that are an unintended consequence of recent changes in postgraduate training, as well as the organisation of the National Health Service. We conclude with some suggestions for psychiatrists, whether trainee or consultant, to help address the situation.
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Cunnane, J. G. "Drug management of disturbed behaviour by psychiatrists." Psychiatric Bulletin 18, no. 3 (March 1994): 138–39. http://dx.doi.org/10.1192/pb.18.3.138.
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The aggressive, acutely psychotic patient may present in many medical settings. Drugs are usually necessary to avert or abort a crisis yet specific guidance on such management is lacking from standard psychiatric texts. Consultant psychiatrists have a crucial advisory role in these situations but information on their prescribing habits has not been published. This study aims to determine whether there is any consensus on the drug management of the aggressive, acutely psychotic patient by consultant psychiatrists.
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Johansen, Winni. "Understanding and practicing crisis consulting." Journal of Communication Management 21, no. 2 (May 2, 2017): 106–23. http://dx.doi.org/10.1108/jcom-12-2016-0104.
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Purpose The purpose of this paper is to contribute to the literature on management and communication consulting in general, and crisis consulting in particular, by investigating how public relations and communications firms understand crises, crisis management, and crisis communication; how they see themselves practicing crisis consulting; and how they envisage the future of this field of expertise. Design/methodology/approach The study is based on 12 semi-structured in-depth expert interviews with CEOs, board members, senior consultants, and/or partners representing national and international public relations and communications firms operating in Denmark who offer crisis consulting as one of their areas of expertise. Findings Findings demonstrate that crisis consulting is a field in transition, moving away from the traditional focus on image crises in the media handled by former journalists, toward a new focus on issue crises involving other types of stakeholders. Findings also demonstrate that crisis consultants generate important insights into aspects of crisis management and crisis communication hitherto neglected by academic scholars. Practical implications The insights into the professional “world view” of crisis consultants will contribute to the professionalization of the field. Originality/value This is the first major study of crisis consulting as a specific field of expertise within the growing industry of management and communication consulting.
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Bull, Stephen J. "The Role of the Sport Psychology Consultant: A Case Study of Ultra-Distance Running." Sport Psychologist 3, no. 3 (September 1989): 254–64. http://dx.doi.org/10.1123/tsp.3.3.254.
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This article presents a case study describing the contribution of a sport psychology consultant to an ultra-distance runner’s attempt to complete 500 miles (800 kilometers) in 20 days through the deserts of North America. The contribution can be considered in four phases that provide a descriptive framework for the role of a sport psychology consultant: (a) establishing a rapport with the athlete, (b) formulating a psychological profile, (c) evaluating the demands of the athletic pursuit and planning an appropriate mental training program, and (d) ongoing evaluation of progress and crisis intervention.
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Siano, Alfonso, and Maria Palazzo. "Tetra Pak Italy’s ingredient branding: an exploratory case of strategic communication." Journal of Communication Management 19, no. 1 (February 2, 2015): 102–16. http://dx.doi.org/10.1108/jcom-02-2012-0017.
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Purpose – The purpose of this paper is to focus on the role ingredient branding (IB) plays in shaping the strategic communications created by public relations/corporate communication departments of large organizations when managing crises. Design/methodology/approach – Starting from a literature review on strategic communication and IB the role of this activity is studied within the Italian context. In order to reach the aim of the paper, primary and secondary sources were exploited generating qualitative and quantitative data. The primary data were gathered though in-depth interviews with key management personnel while the secondary data were sourced from reports made available by Tetra Pak Italy. Findings – The study confirmed the contribution of the strategic proactive role played by Tetra Pak Italy managers of External Relations and Marketing Departments and the communication agency manager during a challenging period of crisis for the company. The main implication of the paper lies in the analysis of the important strategic work implemented by the external consultant of communication together with the External Relations and Marketing managers as members of the dominant coalition. Originality/value – The paper analyses a Tetra Pak Italy case study, as an exploratory case that could demonstrate how strategic communication – based on an IB campaign – is of fundamental importance during a period of crisis. Moreover, the research studied how proactive and effective the role played by the communication consultant and managers of External Relations and Marketing Departments was as a determinant of resulting outcomes.
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Wright, Christopher, and Paul Gilding. "Imagining the climate crisis and the great disruption: an interview with Paul Gilding." Organization 20, no. 5 (September 2013): 757–66. http://dx.doi.org/10.1177/1350508413489820.
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Paul Gilding has had an extensive career in environmental activism and as a sustainability consultant to major global companies. His recent book The Great Disruption (Gilding, 2011), argues that consumer capitalism has reached it ecological and economic limits and we are entering a fundamental crisis. The following edited interview was conducted with Paul in January 2013 and explores how he imagines the future of a climate-shocked world.
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Ingram, Graham, and Mary Jane Tacchi. "Service innovation in a heated environment: CATS on a hot tin roof." Psychiatric Bulletin 28, no. 11 (November 2004): 398–400. http://dx.doi.org/10.1192/pb.28.11.398.
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Over the past few years, numerous articles have highlighted the strain on (and drain of staff from) our specialty. Many general adult psychiatrists are developing bleak views of themselves, the world and the future. Encouragingly, consultants such as Hampson (2003) are structuring their roles with some success. However, we are going through a major overhaul of the model of delivery of care and need to adapt our roles accordingly. Although tuning a Triumph Spitfire might make it run more smoothly for a while, it is still an inferior beast compared with a modern car and might be better on the scrap heap. A more radical approach is needed, which we outline in this article. One of the authors (G.I.) has experience of working as a consultant psychiatrist in Australia, where the state of Victoria changed the model of delivery of general adult psychiatric services to adopt a superior American model, leading to improved patient and carer satisfaction (Joyet al, 2001). The same model has been adopted by the UK government (Department of Health, 2001) through the creation of crisis assessment and treatment services (CATS), assertive outreach teams, and specialist community and in-patient services. Consultant psychiatrists are challenged to adapt their practice accordingly. The Royal College of Psychiatrists has recently set up a Working Group to address this issue (Royal College of Psychiatrists, 2004).
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Siregar, Isyraqi Khairy, and Kurniati Putri Haeirina. "KOMUNIKASI KRISIS PT. JOUSKA FINANSIAL INDONESIA DALAM PEMULIHAN CITRA PERUSAHAAN." Jurnal Pustaka Komunikasi 4, no. 1 (April 14, 2021): 1–10. http://dx.doi.org/10.32509/pustakom.v4i1.1301.
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Jouska is an independent financial advisory company that provides offline and online consulting services that recently went viral in social media and had a strong brand image as a financial consultant related to today's needs. In July 2020, social media was outraged by the complaint, which claimed to have been harmed by them, because Jouska allegedly directed their clients to determine an Investor Fund Account Management Contract (RDI) with PT Mahesa Strategies Indonesia, whose shares are affiliated with Jouska. However, during the development, the client experienced a significant loss in the shares. This situation turned out to be similar complaints from other clients until Jouska underwent a crisis that led to the government's blocking, and the case ended in the realm of law. This study aims to analyze the communication that presents Image Restoration Theory through a lens. The method used in this research is descriptive qualitative, and it was found that Jouska did not yet have a clear SOP for communication with clients and had not implemented crisis management appropriately. There are several recommendations that Jouska can achieve to restore public trust, including collaborative action with various parties, building a communication strategy, and optimal media relations.
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Greenstone, James L. "How to Be a Mental Health Consultant to a Law Enforcement Hostage and Crisis Negotiation Team." Journal of Police Crisis Negotiations 3, no. 1 (April 28, 2003): 121–30. http://dx.doi.org/10.1300/j173v03n01_09.
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Klotsche, J., I. Foeldvari, O. Kasapcopur, A. Adrovic, K. Torok, V. Stanevicha, J. Anton, et al. "SAT0500 HOW THE ADULT CRISS WORKS IN PEDIATRIC jSSc PATIENTS - RESULTS FROM THE JUVENILE SCLERODERMA INCEPTION COHORT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1206.2–1206. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2298.
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Background:The Composite Response Index in Systemic Sclerosis (CRISS) was developed by Dinesh Khanna as a response measure in patients with adult systemic sclerosis. CRISS aims to capture the complexity of systemic sclerosis and to provide a sensitive measure for change in disease activity. The CRISS score is based on a two-step approach. First, significant disease worsening or new-onset organ damage is defined as non-responsiveness. In patients who did not fulfill the criteria of part one, a probability of improvement is calculated for each patient based the Rodnan Skin Score (mRSS), percent predicted forced vital capacity (FVC%), patient and physician global assessments (PGA), and the Health Assessment Questionnaire Disability Index (HAQ-DI). A probability of 0.6 or higher indicates improvement.Objectives:The objective of this study was to validate the CRISS in a prospectively followed cohort of patients with juvenile systemic sclerosis (jSSc).Methods:Data from the prospective international inception cohort for jSSc was used to validate the CRISS. Patients with an available 12-months follow-up were included in the analyses. Clinically improvement was defined by the anchor question about improvement (much better or little better versus almost the same, little worse or much worse) in patients overall health due to scleroderma since the last visit provided by the treating physician.Results:Forty seven jSSc patients were included in the analysis. 74.2% had diffuse subtype. The physician rated the disease as improved in 34 patients (72.3%) since the last visit. No patient had a renal crisis or new onset of left ventricular failure during the 12-months follow-up. Three patients (3.4%) each had a new onset or worsening of lung fibrosis and new onset of pulmonary arterial hypertension. In total, 6 patients resulted in a rating of not improved based on the CRISS in part I. The mRSSS, FVC%, CHAQ and PGA significantly improved during the 12-months follow-up in patients who were rated as improved. The predicted probability based on the CRISS algorithm resulted in an area under curve of 0.77 predicting the anchor question of improvement. In summary, 33 (70.0%) patients were correctly classified by the adult CRISS score resulting in an overall area under curve of 0.7.Conclusion:The CRISS score was evaluated in a pediatric jSSc cohort for the first time. It showed a good performance. However, it seems that the formula of part II of the CRISS score needs a calibration to pediatric jSSc patients.Disclosure of Interests:Jens Klotsche: None declared, Ivan Foeldvari Consultant of: Novartis, Ozgur Kasapcopur: None declared, Amra Adrovic: None declared, Kathryn Torok: None declared, Valda Stanevicha: None declared, Jordi Anton Grant/research support from: grants from Pfizer, abbvie, Novartis, Sobi. Gebro, Roche, Novimmune, Sanofi, Lilly, Amgen, Grant/research support from: Pfizer, abbvie, Novartis, Sobi. Gebro, Roche, Novimmune, Sanofi, Lilly, Amgen, Consultant of: Novartis, Sobi, Pfizer, abbvie, Consultant of: Novartis, Sobi, Pfizer, abbvie, Speakers bureau: abbvie, Pfizer, Roche, Novartis, Sobi, Gebro, Speakers bureau: abbvie, Pfizer, Roche, Novartis, Sobi, Gebro, edoardo marrani: None declared, Maria T. Terreri: None declared, Flávio R. Sztajnbok: None declared, Cristina Battagliotti: None declared, Lillemor Berntson Consultant of: paid by Abbvie as a consultant, Speakers bureau: paid by Abbvie for giving speaches about JIA, Despina Eleftheriou: None declared, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Farzana Nuruzzaman: None declared, Nicola Helmus: None declared
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Allen, Danny, Wendy Blaylock, and Stefan Mieczkowski. "Local implementation of the crisis model: the Buckinghamshire community acute service." Psychiatric Bulletin 33, no. 7 (July 2009): 252–54. http://dx.doi.org/10.1192/pb.bp.107.018499.
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Aims and MethodBuckinghamshire crisis and home treatment team was struggling to meet its commissioned care episodes and found itself detached from community mental health teams (CMHTs) and acute day hospitals. An operations management consultant, using ‘lean’ principles developed in industry, worked alongside staff to redesign the service.ResultsImprovements in staff capacity and ability contributed to more care episodes and reduced ward-stay times, compensating for the impact of a ward closure. Re-examination of individuals needs through case-review led to the development of ‘patient typing’, facilitating clear care pathways according to need. Finally, two proven modalities of community-based service were fused together.Clinical ImplicationsPlacing value to patients, carers and referrers ahead of old demarcations and practices has enabled a more flexible and responsive service to develop and grow.
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Ngumar, Sutjipto. "PELUANG AKUNTAN PUBLIK DALAM PROGRAM RESTRUKTURISASI UTANG BAGI USAHA KECIL DAN MENENGAH." EKUITAS (Jurnal Ekonomi dan Keuangan) 4, no. 2 (November 25, 2016): 91. http://dx.doi.org/10.24034/j25485024.y2000.v4.i2.1903.
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This paper is prapared to analyse the industrialist’s problems, particulary the little and Midle Business (UKM), paying their debt to the Bank, as the result of economic crisis endlesly. The government through the Jakarta Initiative Task Force (J.I.T.F.) and Fi-nancial Consultant, the Public Accountant which is appointed by Indonesian Accountant Asso-ciation (IAI), go to work as the facilitator, practice debt restructuring program, between obligator and creditor by win and win solution. lution. Public accountant is the partner of JITF as Financial Consultant, prepares the informations : e.g. debt’s document, Fi-nancial Statement, activity and strategy of business. The UKM’s information which have been arranged by public accountant used as another base for debt negotiation. The UKM among restructuring obtacle is that the information about restructuring process is not complete; the lack information of obligator and unhonesty of creditor.
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Cope, Denise. "General adult and old age psychiatry specialist registrar training – crisis looming?" Psychiatric Bulletin 27, no. 4 (April 2003): 152–54. http://dx.doi.org/10.1192/pb.27.4.152.
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Aims and MethodsA postal questionnaire was sent to 31 Specialist Registrar Training Programme Directors in general adult and old age psychiatry in England, Scotland and Wales to ascertain the recruitment position on their training scheme and their views on recruitment.ResultsThere was no recruitment to 24% of specialist registrar (SpR) posts. A 17% increase in national training numbers in general adult and old age psychiatry had occurred in the schemes surveyed during the past 2 years. An insufficient number of senior house officer (SHO) posts was identified by 42% of respondents and the unattractiveness of general adult psychiatry recorded by 58% of respondents as factors in under-recruitment.ImplicationsUnder-recruitment at consultant level in general adult and old age psychiatry is being replicated at specialist registrar level. Trainees are not being encouraged into higher psychiatric training by increasing specialist registrar national training numbers. Insufficient SHO posts and the perceived unattractiveness of general adult psychiatry appear as significant factors contributing to poor recruitment at SpR level.
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Cope, Denise. "General adult and old age psychiatry specialist registrar training – crisis looming?" Psychiatric Bulletin 27, no. 04 (April 2003): 152–54. http://dx.doi.org/10.1192/s0955603600001872.
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Aims and Methods A postal questionnaire was sent to 31 Specialist Registrar Training Programme Directors in general adult and old age psychiatry in England, Scotland and Wales to ascertain the recruitment position on their training scheme and their views on recruitment. Results There was no recruitment to 24% of specialist registrar (SpR) posts. A 17% increase in national training numbers in general adult and old age psychiatry had occurred in the schemes surveyed during the past 2 years. An insufficient number of senior house officer (SHO) posts was identified by 42% of respondents and the unattractiveness of general adult psychiatry recorded by 58% of respondents as factors in under-recruitment. Implications Under-recruitment at consultant level in general adult and old age psychiatry is being replicated at specialist registrar level. Trainees are not being encouraged into higher psychiatric training by increasing specialist registrar national training numbers. Insufficient SHO posts and the perceived unattractiveness of general adult psychiatry appear as significant factors contributing to poor recruitment at SpR level.
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Lebedeva, T. Yu, L. V. Minaeva, and A. D. Krivonosov. "COVID-19 Pandemic as a Factor for the Paradigm Shift in International Communications. Book Review of ‘Pandémie médiatique. Com de crise/crise de com’ by S. Fouks." Moscow University Bulletin of World Politics 13, no. 1 (April 7, 2021): 223–40. http://dx.doi.org/10.48015/2076-7404-2021-13-1-223-240.
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The review examines a new book ‘Media pandemic. Crisis communication / communication crisis’ (‘Pandémie médiatique. Com de crise / crise de com’) by the executive vice-president of the Havas Group Stephan Fouks, which was published in the midst of the COVID-19 pandemic. Building on his rich and unique practical experience as a head of a large media organization, a consultant at international organizations and a presidential campaign manager, the author assesses the role of media communications in the context of the coronavirus outbreak. The book under review is addressed primarily to experts in International Relations. It covers a wide range of issues including the causes of the crisis, which led to a paradigm shift in international communications, and specifi cs of the communication policies in France and some other European states. The author concludes that these policies refl ect a general crisis of the ruling elites (political establishment). Here the author continues to further elaborate on the ideas of his previous book — ‘The New Elites: portrait of a generation that will ignore’ (‘Les Nouvelles Elites: portrait d’une génération 1ui s’ignore’).The author provides a critical analysis of the key elements of communication strategies during the COVID-19 pandemic, from the ruling elites to the expert community, and delineates methods and the role of international communication in the future. The reviewers emphasize that the monograph by Stefan Fouks goes beyond the traditional formats of communication studies, which tended to focus either on the various crises, or on the organization of media structures in diff erent states, public-private partnership, and corporate communications, and thus were too narrow in scope. In ‘Media-pandemic’ the author stresses multidimensional nature of international communications and argues that their paradigmatic shift was brought by both the development of digital technologies and anthropogenic factors in the form of the global COVID-19 pandemic.
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WIEVIORKA, Michel. "PREVENTING AND EXITING VIOLENCE: ADOMAIN FOR SOCIOLOGY?" Monitoring of public opinion economic&social changes, no. 5 (November 10, 2018): 0. http://dx.doi.org/10.14515/monitoring.2018.5.08.
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Preventing and exiting violence is a central problem of social sciences. Violence-related information mainly comes from medical specialists, consultant psychiatrists, experts, lawyers, diplomatic officials, representatives of NGO and others. Today this area of knowledge needs a separate discipline operating at individual and group level (recovery of victims or punishment for abusers), national level (building democracy or justice during the interregnum) and global level (for example, how the ISIL activities will shape the situation in the Middle East). Nonetheless, the idea of transformation of violence, crisis logic, discourse and institutional conflicts is core.
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Jombo, GTA, MS Odimayo, TM Adaja, AM Onoja, and BA Ojo. "Giving Correct names to Disciplines in Pathology in the 21st Century: A Review of Working Environments among Pathologists across Nigeria." Western Journal of Medical and Biomedical Sciences 1, no. 1 (June 15, 2020): 35–42. http://dx.doi.org/10.46912/wjmbs.4.
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A name gives one identity, inspiration, strength, vision and an ability to see far into the future end from the beginning. Pathology disciplines therefore need correct and proper names that will carry along it all those attributes to enable them explore all her potentials unhindered in the 21st century practice of Medicine in the country. This study reviewed the functions of Medical Microbiologists and Haematologists in the midst of incessant inter-professional rivalry involving medical laboratory scientist in the country's teaching hospitals. Data was collected based on information from electronic, online and print media, and social media platforms. Questionnaires were administered to assess the knowledge of students of Adeyemi College of Education Ondo-City on the difference between Consultant Medical Microbiologists and Academic Microbiologists. We found out that in over 85% of the crisis in the medical laboratories in the country are from either Medical Microbiology and or Haematology laboratories; disciplines whose names have little to do with pathology, and that Anatomic Pathology and Chemical Pathology disciplines are usually only in solidarity with the two. Also other health personnel including scientists do not feel fully convinced that Consultants in the former two disciplines (Medical Microbiology and Haematology) are truly Pathologists. It was also found that 90% of members of the general public cannot differentiate between a Pathologist who specializes in Microbiology from an individual who graduated with BSc or MSc in Microbiology and so could hardly understand why such could not also practice as Consultant Microbiologist or Lecture in Clinical Pathology departments. At the University of Medical Sciences teaching Hospital Complex (UNIMED THC) where both the discipline and the Department are named Microbial Pathology, the tension has substantially been put under check. The two subspecialties should be properly named as: Microbial Pathology and Haematologic Pathology instead of Medical Microbiology and Parasitology, and Haematology respectively along with their respective Departments.
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Pla Salas, X., C. Tolosa, A. Guillén del Castillo, M. E. Sánchez García, J. Sánchez-Redondo, E. L. Callejas-Moraga, L. Sáez-Comet, et al. "THU0361 EPIDEMIOLOGIC VARIATION ON SCLERODERMA RENAL CRISIS AND CLINICAL FEATURES VARIATION ON SYSTEMIC SCLEROSIS PATIENTS OVER TIME: DATA FROM RESCLE REGISTRY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 411.1–412. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1353.
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Background:Scleroderma renal crisis (SRC) prevalence is decreasing. However, no Systemic Sclerosis (SSc) patient’s registry has evaluated that decrease over time. No treatment have been able to prevent SRC development.Objectives:Primary objective: to identify SRC prevalence in 2 periods in the RESCLE(Registro deESCLErodermia) registry. Secondary objective: to idenfy which features could justify that change on SRC prevalence.Methods:Up to December 2018, 1937 SSc patients were included by 31 referral centers in RESCLE registry. SRC prevalence and incidence in diagnosed patients before and after 2003 was determined. Clinical characteristics of diagnosed patients in each period of time were analysed to identify differences between them.Results:Out of 1937 SSc, 43 (2.2%) developed SRC. Prevalence of SRC before and after 2003 was 3.5% and 1.08%. SRC Incidence: Graphic 1. Significant differences between Pre-2003 vs. Post-2003 SSc cohorts were found in univariate analysis: Table 1 and 2.Table. 1.Univariate analysisPre-2003(%)Post-2003(%)Demographic datalcSSc6359dcSSc2815ssSSc6.414Early SSc1.13.3Very early SSc1.99.6Age at SSc dx49.1(±15.2)y55.0(±15.6)yTime from SSc dx to SRC1.1(0.2-4.3)y0.6(0.1-1.5)yACR/EULAR 2013 criteria9986ComorbiditiesSmoked2037Arterial hypertension3529Diagnostic proceduresPAPs >40mmHg by Echocardiography3825Not-sclerodermal pattern at VCS8.919Lupus anticoagulant124.8Prognostic featuresOverall mortality2911ILD-related death101.6Conclusion:SRC Prevalence and Incidence has decreased. Prevalence is three-fold in diagnosed SSc cohort pre-2003 than in post-2003. The post-2003 cohort showed lesser prevalence of dcSSc subtype, earlier SSc diagnosis, less organic involvement and more intensive treatment than pre-2003 cohort. All these findings could explain the decline in the SRC prevalence.Figure:Table 2.Univariate analysisPre-2003 (%)Post-2003 (%)Clinical dataSkin sclerosis (as 1stsymptom)7.24.1Digital ulcers4931Telangiectasia6652Acroosteolysis124.6Calcinosis2914Joint contractures2813ILD4937Cardiac conduction alteration2027Left diastolic dysfunction4132Peripheral neuropathy136.1Sicca syndrome3724Treatment featuresCalcium channel blockers2340Specific vasodilators2.114Prostaglandin0.993.4Angiotensin system inhibitors5.116Corticosteroids1120Immunosuppressant315y: years old; lcSSc: limited cutaneous SSc; dcSSc: diffuse cutaneous SSc; ssSSc: sine scleroderma SSc; ILD: Interstitial lung disease; PAPs: systolic Pulmonary Arterial Pressure; VCS: Video-capillaroscopy; dx: diagnosisDisclosure of Interests:Xavier Pla Salas: None declared, Carles Tolosa Consultant of: Actelion pharmaceuticals, GSK, MSD., Alfredo Guillén del Castillo: None declared, María Esther Sánchez García: None declared, Jorge Sánchez-Redondo: None declared, Eduardo L. Callejas-Moraga: None declared, Luis Sáez-Comet: None declared, Jose Antonio Vargas-Hitos: None declared, Jose Antonio Todolí Parra: None declared, Luis Trapiella Martínez: None declared, Ignasi Rodriguez-Pubto: None declared, Mayka Freire: None declared, Isaac Pons Martin del Campo: None declared, Vicent Fonollosa-Pla Consultant of: Actelion pharmaceuticals, GSK, MSD., Carmen Pilar Simeón-Aznar Consultant of: Actelion pharmaceuticals, GSK, MSD., on behalf of RESCLE Investigators, Autoimmune Diseases Study Group (GEAS): None declared
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Apiratwarakul, Korakot, Takaaki Suzuki, Ismet Celebi, Somsak Tiamkao, Vajarabhongsa Bhudhisawasdi, Dhanu Gaysonsiri, and Kamonwon Ienghong. "Real Time Telephone Application Use for Consultation in Emergency Medical Services." Open Access Macedonian Journal of Medical Sciences 9, E (May 14, 2021): 390–93. http://dx.doi.org/10.3889/oamjms.2021.6150.
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BACKGROUND: Emergency medical services (EMS) are an operation that requires speed and prompt decision-making to provide patients treatment and rescue them from crisis. A telephone application was created to be a communication channel. However, the effectiveness of EMS consulting via telephone application has not been well studied.
AIM: The aim of this study was to describe the use of real-time telephone application use for consultation in EMS.
METHODS: A cross-sectional, single EMS centered study at Srinagarind Hospital in Thailand. Data were gathered from LINE® Application under the name of “Current training EMKKU” and the EMS database throughout 2020-2021.
RESULTS: A total of 11550 messages with 6221 general text; messages were not involved in patients’ consultant (53.86%). The consultation mostly took place during the afternoon shifts (4PM to 0AM) accounted for 45.11%. We found that Thursday (19.63%) was the day with most frequent consulting services, followed by Tuesday (16.05%) and Friday (16.03%) regarding the consultation. There were 45 active users in the LINE® Application under the name of “Current training EMKKU”. The mean age of the participants was 32.10±5.60 years, and 51.11% (n = 23) of them was female.
CONCLUSIONS: The real-time telephone application is used for consultation related to patients' symptoms during EMS operations and ER patient care was most commonly in the afternoon and on Thursdays and Tuesdays.
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Клычова, Гузалия, Guzaliya Klychova, Алсу Закирова, Alsu Zakirova, Альфия Юсупова, Al'fiya Yusupova, Айгуль Клычова, and Augul Klychova. "DEVELOPMENT OF THEORETICAL BASES OF ADMINISTRATIVE CONSULTING." Vestnik of Kazan State Agrarian University 13, no. 1 (August 1, 2018): 162–68. http://dx.doi.org/10.12737/article_5afc1849ee1c83.60642945.
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Management consultancy at the current stage of economic development is a factor that contributes to the efficiency and competitiveness of most enterprises through a comprehensive analysis of the management system and the solution of key problems, arising in management activities. Implementation of various innovative, anti-crisis, diversification and other complex projects proves the necessity to appeal to highly qualified consultants for professional assistance. The requests of organizations contribute to the modification of technologies and methods of management consulting. The economic essence of management consulting is considered in the article, the conceptual model of management consulting is formed, in which the elements forming the theoretical basis of the modern concept of management consulting are conceptually specified and structured.
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Sethi, Faisil, John Parkes, Eric Baskind, Brodie Paterson, and Aileen O'Brien. "Restraint in mental health settings: is it time to declare a position?" British Journal of Psychiatry 212, no. 3 (February 5, 2018): 137–41. http://dx.doi.org/10.1192/bjp.2017.31.
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SummaryThe emergence of a drive to reduce restrictive interventions has been accompanied particularly in the UK by a debate focussing on restraint positions. Any restraint intervention delivered poorly can potentially lead to serious negative outcomes. More research is required to reliably state the risk attached to a particular position in a particular clinical circumstance.Declaration of interestF.S. is a consultant psychiatrist in Psychiatric Intensive Care at the Maudsley Hospital, London. He is on the Executive Committee of the National Association of Psychiatric Intensive Care and Low Secure Units, and was a member of the National Institute for Health and Care Excellence Guideline Development Group for the Short-Term Management of Aggression and Violence (2015). J.P. is a senior lecturer at the Faculty of Health and Life Sciences, Coventry University. E.B. is a consultant and expert witness in violence reduction and the use of physical interventions, independent expert to the High Secure Hospitals Violence Reduction Manual Steering Group and a member of the College of Policing Guideline Committee Steering Group and Mental Health Restraint Expert Reference Group. B.P. is the clinical director for Crisis and Aggression Limitation and Management (CALM) Training and formerly a senior lecturer for the Faculty of Health, University of Stirling. He is a nurse and psychotherapist and presently chairs the European Network for Training in the Management of Aggression. A.O'B. is a consultant psychiatrist, the Director of Educational Programmes for the National Association of Psychiatric Intensive Care and Low Secure Units, and the Dean for Students at St George's University of London.
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Penford, R., E. Wren, and K. Mackay. "AB0909-HPR COVID 19 CRISIS: RAPID DEVELOPMENT OF REMOTE RHEUMATOLOGY MEDICATION CLINICS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1476.2–1477. http://dx.doi.org/10.1136/annrheumdis-2021-eular.4029.
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Background:We used to initiate DMARD(s) and Biologic therapies via nurse-led shared medical appointments (Group clinics) and could see up to 30 patients per week, with a maximum of 6 patients per group. We did this to start patients on their medications efficiently and safely and to manage the increase in workload.However, with the onset of the COVID 19 pandemic, we had to stop these clinics immediately, but, we did not have capacity to start everyone on their medications in a timely manner by telephone. Telephoning each individual took > 9 hours per week, whereas previously it took 3-4 haours.Objectives:We wanted to start patients on their all rheumatology medications safely and efficiently (within 10 days).Methods:By April 2202, we had organised the filming of 10 short healthcare videos to give patients all the information they required to start a range of DMARDs and biologics.We developed a new protocol (fig 1); patients are asked to view the relevant video, contact our department to confirm they understand the safety monitoring, risks, potential side effects, dose increases etc. As soon as they confirm by email they are happy to start treatment, a prescription is generated and emailed to the hospital outpatient pharmacy, where it is dispensed and delivered to the patient’s home. We send a follow up reminder letter about blood test monitoring etc (copy to GP) and a ‘shared care agreement’ to GP. They are given the option to have a telephone clinic appointment with a specialist nurse if required.Figure 1.Results:Of those requiring DMARDs, 62% reviewed the video, completed the checklist and confirmed by email they were happy to start treatment, within 24-hours. 88% had completed within 7 days.Over half the patients (56%) were starting DMARDs for the first time, of those 8% requested a telephone consultation to discuss treatment further with the Rheumatology nurses. Of the 44% of patients already taking a DMARD and due to start a second medication 24% required a telephone clinic appointment.As this is a new service, we asked for feedback, receiving replies from 34%, all scoring between 9/10 and 10/10.We have released > 7 hours of specialist nurse time for telephone/helpline clinics.Conclusion:The development of digital / remote medication clinics has been a success and we will continue with this approach. We have limited face-to-face appointments, started patients on rheumatology medications more quickly and efficiently than previously (but maintained safety), allowed the nursing staff time to spend more time working in our telephone clinics and have had excellent patient feedback. Although, we are aware, this is at a cost of no peer-to-peer interaction, which has been of value in the past.Disclosure of Interests:Rian Penford: None declared, Elaine Wren: None declared, Kirsten Mackay Speakers bureau: I have been paid as a speaker for Roche within the last 12 months, Consultant of: I have worked as a paid consultant for Novartis, Janssen and Lilly within the last 12 moths, Grant/research support from: Novartis have assisted in the development of our Rheumatology App - Connect Plus - developed for rheumatology patients attending our department.
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Del Galdo, F., O. Distler, C. Denton, Y. Allanore, D. Wachtlin, M. Alves, and D. Khanna. "AB0431 EXPLORING THE UTILITY OF THE AMERICAN COLLEGE OF RHEUMATOLOGY (ACR) CRISS IN PATIENTS WITH DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 1244. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1760.
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Background:The ACR Composite Response Index in diffuse cutaneous Systemic Sclerosis (CRISS) was developed to measure the probability of improvement in response to treatment in patients with early diffuse cutaneous SSc (dcSSc), accounting for new/worsening cardiopulmonary involvement and/or renal crisis, and changes in modified Rodnan skin score, forced vital capacity, health assessment questionnaire disability index, and patient’s and physician’s global impressions. In patients with SSc-ILD, treatment response may be reflected as slower progression, stabilisation or improvement.Objectives:Using data from patients with dcSSc and ILD in the placebo group of the SENSCIS trial, we analysed the probability of improvement using the ACR CRISS score at week 52. We also evaluated whether the CRISS numerator could provide information on the spectrum of responses in this patient population.Methods:The SENSCIS trial enrolled subjects with SSc-ILD with onset of first non-Raynaud symptom ≤7 years before screening, FVC ≥40% predicted, and fibrotic ILD ≥10% extent on an HRCT scan. Subjects on prednisone ≤10 mg/day (or equivalent) and/or stable therapy with mycophenolate or methotrexate were allowed to participate. Subjects were randomised to receive nintedanib or placebo. Subjects were not randomised by use of mycophenolate. In patients randomised to receive placebo who had dcSSc and/or mRSS >15 at baseline, we analysed the ACR CRISS and its numerator at week 52 in subgroups by use of mycophenolate at baseline. Analyses were exploratory and descriptive.Results:Of 117 analysed subjects in the placebo group who had dcSSc and/or mRSS >15 at baseline, 60 (51.3%) were taking mycophenolate at baseline. Compared with patients not taking mycophenolate at baseline, those taking mycophenolate had a lower mean age (48.4 [SD 11.8] vs 53.1 [13.4] years), lower mean FVC % predicted (68.8 [17.0] vs 73.0 [14.6]), and a greater proportion were female (76.7% vs 71.9%); median time since first onset of non-Raynaud symptom was similar (3.9 vs 4.5 years, respectively) as was mean (SD) mRSS (16.5 [7.7] vs 15.9 [8.0], respectively). One patient (taking mycophenolate at baseline) had limited cutaneous SSc. At week 52, median (Q1, Q3) ACR CRISS score was 0.036 (0.001, 0.601) in subjects taking mycophenolate and 0.002 (0.000, 0.112) in subjects not taking mycophenolate at baseline, and mean (SD) ACR CRISS score was 0.28 (0.37) in subjects taking mycophenolate and 0.16 (0.31) in subjects not taking mycophenolate at baseline (Figure 1). In these groups, respectively, 25.0% and 14.0% of subjects had CRISS score >0.6 (considered improved) at week 52. The CRISS numerator provided a broader distribution of response values, but was not informative in this patient population.Conclusion:In exploratory analyses, among subjects with dcSSc and ILD who received placebo in the SENSCIS trial, the proportion considered improved at week 52 based on ACR CRISS score was numerically greater in patients taking than not taking mycophenolate at baseline. There remains a need for composite scores that provide better interpretation of the magnitude of response in patients with SSc.Acknowledgements:The SENSCIS trial was funded by Boehringer Ingelheim. Medical writing support was provided by FleishmanHillard Fishburn, London, UK. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE).Disclosure of Interests:Francesco Del Galdo Speakers bureau: Actelion and AstraZeneca, Consultant of: Actelion, AstraZeneca, Boehringer Ingelheim, Capella BioScience, ChemomAb and Mitsubishi Tanabe Pharma, Grant/research support from: Capella BioScience, Kymab and Mitsubishi Tanabe Pharma, Oliver Distler Consultant of: AbbVie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Bayer, Blade Therapeutics, Boehringer Ingelheim, ChemomAb, Corbus, CSL Behring, Galapagos NV, GlaxoSmithKline, Glenmark Pharmaceuticals, Horizon (Curzion) Pharmaceuticals, Inventiva, IQVIA, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Target Bioscience, Topadur Pharma and UCB, Grant/research support from: Kymera Therapeutics and Mitsubishi Tanabe Pharma, Christopher Denton Speakers bureau: Boehringer Ingelheim, Corbus, Janssen, and Mallinckrodt Pharmaceuticals, Consultant of: Acceleron Pharma, Arxx Therapeutics, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos NV, GlaxoSmithKline, Horizon Therapeutics, Janssen, Mallinckrodt Pharmaceuticals, Roche, Sanofi and UCB, Grant/research support from: Arxx Therapeutics, GlaxoSmithKline and Servier, Yannick Allanore Consultant of: Boehringer Ingelheim, Medsenic, Menarini and Sanofi, Grant/research support from: Alpine Pharmaceuticals, Daniel Wachtlin Employee of: Currently an employee of Boehringer Ingelheim, Margarida Alves Employee of: Currently an employee of Boehringer Ingelheim, Dinesh Khanna Shareholder of: Eicos Sciences, Inc. (less than 5%), Consultant of: Acceleron Pharma, Actelion, AbbVie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead Sciences, Galapagos NV, Genentech/Roche, GlaxoSmithKline, Horizon Therapeutics, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis and United Therapeutics, Grant/research support from: Bayer, Bristol-Myers Squibb, Horizon Therapeutics, Immune Tolerance Network, National Institutes of Health and Pfizer, Employee of: Chief Medical Officer- CiviBioPharma/Eicos Sciences, Inc.
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Patel, Dipam A., and Chirag Narendrakumar Shah. "Navigating Through the Financial Crisis that may Occur during and after the COVID-19 Pandemic for Gastroenterologists." Journal of Digestive Endoscopy 11, no. 01 (March 2020): 76–80. http://dx.doi.org/10.1055/s-0040-1712345.
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Abstract Introduction Considering the specific set of gastrointestinal endoscopy practitioners, it is witnessed that the number of patients forelective procedures are being deferred by the patients amid various concerns ranging from financial constraint to the fear of infection from the dreaded coronavirus. With Routine endoscopy procedures recommended to be safely postponed, the impact on the practice of Gastrointestinal Endoscopists shall be magnified. Assessment and Strategy The article discusses impact and remedial actions that may be taken by Gastrointestinal Endoscopists, which classified into:- Anindependent practitioner- A consultant- An employeeThe article further touches upon the difficulties that might be envisaged by the Gastrointestinal Endoscopists, and obtain a financial understanding of what could potentially lead to an existential crisis?Those with cash reserves sit in a pleasant position i.e. they can buy assets at an attractive price, experiment with new ideas, research and development, etc. It is imperative in these times to understand the uncertainty cast on operations of Gastrointestinal Endoscopists and prepare a response plan for coming out of this economic crisis. A roadmap also has been devised which provides a possible outline of a plan that can be implemented for handling the economic crisis.It is also important to answer these two questions:1. Who do I want to be during the crisis?2. Who do I want to be when this is over?
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Tyrer, Peter. "The future of specialist community teams in the care of those with severe mental illness." Epidemiologia e Psichiatria Sociale 16, no. 3 (September 2007): 225–30. http://dx.doi.org/10.1017/s1121189x00002323.
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SummaryAims – Specialist interventions in community psychiatry for severe mental illness are expanding and their place needs to be re-examined. Methods – Recent literature is reviewed to evaluate the advantages and disadvantages of specialist teams. Results – Good community mental health services reduce drop out from care, prevent suicide and unnatural deaths, and reduce admission to hospital. Most of these features have been also demonstrated by assertive community outreach and crisis resolution teams when good community services are not available. In well established community services assertive community teams do not reduce admission but both practitioners and patients prefer this service to other approaches and it leads to better engagement. Crisis resolution teams appear to be more successful than assertive community teams in preventing admission to hospital, although head- to-head comparisons have not yet been made. All specialist teams have the potential of fragmenting services and thereby reducing continuity of care. Conclusions – The assets of improved engagement and greater satisfaction with assertive, crisis resolution and home treatment teams are clear from recent evidence, but to improve integration of services they are probably best incorporated into community mental health services rather than standing alone.Declaration of Interest: The author has been the sole consultant in two assertive outreach teams since 1994 and might there- fore be expected to be in favour of this genre of service. He has received grants for evaluation of different services models from the Department of Health (UK) and the Medical Research Council (UK).
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Kumari, Mamta, Arun Kumar Gupta, and Peter Clarke. "Off-label prescribing of quetiapine in south locality crisis teams." BJPsych Open 7, S1 (June 2021): S87. http://dx.doi.org/10.1192/bjo.2021.267.
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AimsThe audit was carried out to determine the frequency of off label prescribing of quetiapine and compliance with standards within Trust Policy (UHM PGN 02 PPT PGN 08) – Physical Health Monitoring of Patients Prescribed Antipsychotics and other Psychotropic Medicines, NICE CG178, General Medical Council Ethical Standards and Royal College of Psychiatrists – College Report CR210.The main objectives of the audit were to determine if:Patients have been appropriately informed of off-label status and consent recorded.Alternative licensed treatment first used/ruled out.Appropriate communication on transfer of care.Appropriate physical health monitoring completed.BackgroundQuetiapine is associated with various physical side effects. Patients should be fully informed of the expected risks and benefits of treatment, and the limited evidence base for off-label prescribing.There are additional issues around the transfer of prescribing to primary care.MethodThe sample consisted of 50 consecutive patients selected from the crisis team caseload in the month of December 2018.Data reviewed in this audit were taken from six months period.Records audited were obtained from RiO (electronic records) and prescription charts.Data collection was started in January 2019 and completed in March 2019The audit tool was a dichotomous scale questionnaire based on NICE guidelines.Result4 patients from the sample (8%) were prescribed off-label quetiapine.100% had physical health monitoring completed as per Trust policy.100% off-label indication been clearly documented in notes.100% Consent to treatment was documented.100% had medication reviewed in the previous 6 months.75% had licensed medication used or ruled out before considering off-label quetiapine use25% risks/benefits of treatment were documented as part of a patient discussion.25% had documented evidence that alternative treatment options were discussed.25% had documented evidence of Community consultant/GP consent/agreement was obtained before transfer of prescribing75% had a documented plan for review of quetiapine for treatment efficacy and side effects50% had a documented plan in place for ongoing physical health monitoringConclusionSuggested a wider audit may be required with greater patient numbers and which specifically filters for patients prescribed quetiapine.Audit result has been shared with Crisis team members, Medicines Optimisation Committee and South Locality Quality Standards Committee in the trust.
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Vogelpohl, Anne. "Consulting completed: temporal aspects of expertise in urban development during times of fast policies." Geographica Helvetica 72, no. 1 (February 2, 2017): 65–76. http://dx.doi.org/10.5194/gh-72-65-2017.
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Abstract. Consultants, especially management consultants with their expertise in markets and entrepreneurial thinking, have gained a new role in urban policy. Urban politicians, facing ever-increasing international competition as well as diverse urban crises, search for immediate solutions, at times drawing on professional advice. This paper introduces the role of management consultants in urban policy in the context of fast policies. These new policies are often both developed over short periods of time and built upon predesigned concepts. Taking six German cities as examples, I frame the impact both of the duration of consultancy projects and of the moment when the consultants leave as temporal aspects of expertise that significantly influence how the external knowledge eventually shapes local political practices. I show that short-term consulting first causes a stimulus for change but then primarily results in an ambivalent amalgamation of professionalization and selectivity as permanently fast modes of everyday policymaking.
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Wyss, A., S. Jordan, N. Graf, E. Siegert, L. Czirják, A. Doria, A. Giollo, et al. "FRI0265 IS AN IMPROVEMENT IN SKIN FIBROSIS ASSOCIATED WITH BETTER OUTCOME IN PATIENTS WITH SYSTEMIC SCLEROSIS? A EUSTAR ANALYSIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 717.1–717. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5860.
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Background:In previous studies, we showed that in patients with diffuse cutaneous systemic sclerosis (dcSSc), worsening of skin fibrosis predicts later decline in lung function and worse survival. However, in many patients, an improvement of skin fibrosis is the natural course of dcSSc, and many current clinical trials are designed to show improvement of skin fibrosis rather than prevention of skin fibrosis progression.Objectives:To investigate whether an improvement in skin fibrosis is associated with less progression of visceral organ involvement and better overall-survival during follow-up.Methods:We evaluated patients from the European Scleroderma Trials and Research Group (EUSTAR) database with diffuse cutaneous systemic (dcSSc), baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 follow-up visit. Regression of skin fibrosis was defined as a decrease in mRSS >5 and ≥25% and progression as increase by the respective numbers from baseline to 12±3 months. Outcomes were pulmonary progression, cardiac progression, intestinal progression, new onset of scleroderma renal crisis and all-cause death using recently specified definitions (1). Associations between skin changes and outcomes were evaluated by Kaplan-Meier analysis and multivariable Cox regression.Results:Of 1257 included patients, 282 (22.4%) showed a regression of skin fibrosis, 883 (70.2%) were categorized as stable patients and 92 (7.3%) showed progression of skin fibrosis at 12±3 months. Median long-term follow-up for organ involvement/death was 4.2 years. Cox regression analyses indicated that skin fibrosis regression had a significantly lower probability of later FVC decline ≥10% than non-regressive (stable and progressive) patients when controlled for baseline mRSS (p=0.013). No significant association of skin fibrosis regression was found with other organ manifestations or all-cause death. Conversely, associations of skin fibrosis progression were found for later FVC decline ≥10% with a more significant p-value (p<0.001, Figure 1), and there was also an association with all cause death (p=0.026).Conclusion:Progression of skin fibrosis is stronger associated with organ changes and all-cause death at follow up than improvement of skin fibrosis. These data suggest a prevention of progression paradigm for clinical practice. They also suggest that clinical trials designed for prevention of skin fibrosis progression are more meaningful for long-term outcome of SSc patients than trials designed to show improvement of skin fibrosisReferences:[1]Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort. Wu W, Jordan S, Graf N, de Oliveira Pena J, Curram J, Allanore Y, Matucci-Cerinic M, Pope JE, Denton CP, Khanna D, Distler O; EUSTAR Collaborators. Ann Rheum Dis. 2019 May;78(5):648-656Disclosure of Interests:Anja Wyss: None declared, Suzana Jordan: None declared, Nicole Graf: None declared, Elise Siegert Grant/research support from: Actelion, Consultant of: AEC, Speakers bureau: NA, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Andrea Doria Consultant of: GSK, Pfizer, Abbvie, Novartis, Ely Lilly, Speakers bureau: UCB pharma, GSK, Pfizer, Janssen, Abbvie, Novartis, Ely Lilly, BMS, Alessandro Giollo: None declared, Edoardo Rosato: None declared, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Armando Gabrielli: None declared, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche
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Moyseyenko, Valentyna. "DYSLIPIDEMIA: CONTRADICTIONS IN TREATMENT FROM THE POSITIONS OF NEPHROLOGISTS AND CARDIOLOGISTS." Actual Problems of Nephrology 25 (March 19, 2020): 8–13. http://dx.doi.org/10.37321/nefrology.2019.25-01.
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Clinical findings show that there are detectable lipid metabolism in patients with forbidden signs seeking prognosis for subsequent work, not only atherosclerosis and cardiovascular complications, but also nephrosclerosis. The dual process of division into medicine specifically has its advantages in providing highly skilled care, but the targeted multifactorial approach to patients is lost. Most nephrological patients are treated not by nephrologists. Patients with chronic illnesses (CKD) have a real risk of cardiovascular disease, including heart attack, consultant and hypertensive crisis, as well as death. Frequency is higher in patients on hemodialysis. Expansion in the recommendation (Recommendation of European Cardiology Societies and European Society of Atherosclerosis for the Study of Dyslipidemias and others) for lipid-lowering therapy with target profiles of cardiovascular possible adverse effects on the effectiveness of CKD lines. When prescribing lipid-lowering therapy it is very important to evaluate the safety of drugs, in particular their possible nephrotoxicity.
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Lindorfer, Simone. "In Whose Interest Do We Work? Critical Comments of a Practitioner at the Fringes of the Liberation Paradigm." Feminism & Psychology 19, no. 3 (July 23, 2009): 354–67. http://dx.doi.org/10.1177/0959353509105626.
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`De-ideologizing reality' is an urgent task within the psychology of liberation. Ignacio Martín-Baró characterized it as a process of conscientization that unmasks power interests underlying knowledge production, retrieves the `original experience of the people', and returns that experience in the form of `objective data'. In contemporary humanitarian trauma work in crisis areas, however, psychology often masks global power structures and further stigmatizes and alienates `victims' from their communities and their original experience. I draw upon my work as a psychologist, theologian and freelance consultant in the Great Lakes Region of Central Africa to analyse two case studies. I use these examples to analyse and critique the underlying power discourses implied in definitions of `victimhood' in humanitarian interventions and identify contradictions that challenge liberation thinking as well as demystify feminist agendas. I conclude by calling for a change of perspective and of professional attitudes that can be realized through engaging a de-ideologizing approach towards global psychosocial trauma interventions.
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Richard Tucker, G. "Summary." Annual Review of Applied Linguistics 10 (March 1989): 243–50. http://dx.doi.org/10.1017/s0267190500001331.
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During the past decade, since the inception of the Annual Review of Applied Linguistics, work in the field has been exciting, socially relevant, and expanding. This trend will likely continue throughout the 1990s and into the 21st Century. A variety of factors—attitudinal, demographic, economic, and sociological to mention but a few—will converge and lend urgency to the need for language educators to broaden their work. From a vantage point at the Center for Applied Linguistics, I have been repeatedly amazed during the past several years at the increasing attention focused on language issues—notice, for example, the concern with the workplace literacy crisis, the under-representation of language minority individuals in science and mathematics education and in technical fields; the continuing monolinguality of the American population, and with the credibility of young children as witnesses in sexual abuse trials. A discussion of the importance of language and literacy issues may be found today in such formerly unlikely sources as the newest book by the renowned management consultant Peter Drucker (1989). Indeed, during the past 18 months five major reports have appeared—Science for All Americans (American Association for the Advancement of Science 1989), Everybody Counts (National Research Council 1989), Workforce 2000 (Johnston 1987), Jump Start (Chisman 1989), and Turning Points (Carnegie Council on Adolescent Development 1989)—each of which presents and discusses in vivid detail the looming/educational/workplace crisis.
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Foeldvari, I., J. Klotsche, O. Kasapcopur, A. Adrovic, K. Torok, M. T. Terreri, A. P. Sakamoto, et al. "THU0499 IS THERE A DIFFERENT PRESENTATION OF JUVENILE SYSTEMIC DIFFUSE AND LIMITED SUBSET? DATA FROM THE JUVENILE SCLERODERMA INCEPTION COHORT. WWW.JUVENILE-SCLEORDERMA.COM." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 487–88. http://dx.doi.org/10.1136/annrheumdis-2020-eular.1667.
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Background:Juvenile systemic scleroderma (jSSc) is an orphan disease with a prevalence of 3 per 1 000 000 children. There are limited data regarding the clinical presentation of jSSc. The Juvenile Systemic Scleroderma Inception Cohort (JSSIC) is the largest multinational registry that prospectively collects information about jSSc patients.Objectives:Evaluation of the jSSc patients at the time of inclusion in the JSSIC.Methods:Patients were included in the JSSIC if they fulfilled the adult ACR/EULAR classification criteria for systemic scleroderma, if they presented the first non-Raynaud symptom before 16 years of age and if they were younger than 18 years of age at time of inclusion. Patients’ characteristics at time of inclusion were evaluated.Results:Until 15thof December 2019 hundred fifty patients were included, 83% of them being Caucasian and 80% female. The majority had the diffuse subtype (72%) and 17% of all jSSc had overlap features. The mean age of first presentation of Raynaud´s phenomenon was 9.8 years in the diffuse subtype (djSSc) and 10.7 years in the limited subtype (ljSSc) (p=.197). The mean age at first non-Raynaud’s symptoms was 10.0 years in the djSSc and 11.2 years in the ljSSc (p=0.247). Mean disease duration at time of inclusion was 3.4 years in the djSSc and 2.4 years in the ljSSc group.Significant differences were found between the groups regarding mean modified Rodnan skin score, 18.2 in the djSSc vs 6.2 in the ljSSc (p=0.02); presence of Gottron´s papulae (djSSc 30% vs ljSSc 13%, p=0.43);presence of teleangiectasia (djSSc 42% vs 18% ljSS, p=0.01); history of ulceration (djSSc 42% vs 18% ljSSc,p=0.008); 6 Minute walk test below the 10thpercentile (djSSc 85% vs ljSSc 54%, p=0.044), total pulmonary involvement (djSSc 49% vs ljSSc 31%, p=0.045), cardiac involvement (ljSSc 17% vs djSSc 3%, p=0.002). djSSc patients had significantly worse scores for Physician Global Assessment of disease activity compared to ljSSc patients (VAS 0-100) (40 vs 15) (p=0.001) and for Physician Global Assessment of disease damage (VAS 0-100) (36 vs 17) (p=0.001).There were no statistically significant differences in the other presentations. Pulmonary hypertension occurred in approximately 6% in both groups. No systemic hypertension or renal crisis was reported. ANA positivity was 90% in both groups. Anti-Scl70 was positive in 35% in djSSc and 36% in the ljSSc group. Anticentromere positivity occurred in 3% in the djSSc and 7% in the ljSSc group.Conclusion:In this unique large cohort of jSSc patients there were significant differences between djSSc and ljSSc patients at time of inclusion into the cohort regarding skin, vascular, pulmonary and cardiac involvement. According to the physician global scores the djSSc patients had a significantly more severe disease. Interestingly the antibody profile was similar in both scleroderma phenotypes.Supported by the “Joachim Herz Stiftung”Disclosure of Interests: :Ivan Foeldvari Consultant of: Novartis, Jens Klotsche: None declared, Ozgur Kasapcopur: None declared, Amra Adrovic: None declared, Kathryn Torok: None declared, Maria T. Terreri: None declared, Ana Paula Sakamoto: None declared, Valda Stanevicha: None declared, Flávio R. Sztajnbok: None declared, Jordi Anton Grant/research support from: grants from Pfizer, abbvie, Novartis, Sobi. Gebro, Roche, Novimmune, Sanofi, Lilly, Amgen, Grant/research support from: Pfizer, abbvie, Novartis, Sobi. Gebro, Roche, Novimmune, Sanofi, Lilly, Amgen, Consultant of: Novartis, Sobi, Pfizer, abbvie, Consultant of: Novartis, Sobi, Pfizer, abbvie, Speakers bureau: abbvie, Pfizer, Roche, Novartis, Sobi, Gebro, Speakers bureau: abbvie, Pfizer, Roche, Novartis, Sobi, Gebro, Brian Feldman Consultant of: DSMB for Pfizer, OPTUM and AB2-Bio, Ekaterina Alexeeva Grant/research support from: Roche, Pfizer, Centocor, Novartis, Speakers bureau: Roche, Novartis, Pfizer., Maria Katsikas: None declared, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl, edoardo marrani: None declared, Mikhail Kostik: None declared, Natalia Vasquez-Canizares: None declared, Simone Appenzeller: None declared, Mahesh Janarthanan: None declared, Monika Moll: None declared, Dana Nemcova: None declared, Anjali Patwardhan: None declared, Maria Jose Santos Speakers bureau: Novartis and Pfizer, Sujata Sawhney: None declared, Dieneke Schonenberg: None declared, Cristina Battagliotti: None declared, Lillemor Berntson Consultant of: paid by Abbvie as a consultant, Speakers bureau: paid by Abbvie for giving speaches about JIA, Blanca Bica: None declared, Juergen Brunner Grant/research support from: Pfizer, Novartis, Consultant of: Pfizer, Novartis, Abbvie, Roche, BMS, Speakers bureau: Pfizer, Novartis, Abbvie, Roche, BMS, Patricia Costa Reis: None declared, Despina Eleftheriou: None declared, Liora Harel: None declared, Gerd Horneff Grant/research support from: AbbVie, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Speakers bureau: AbbVie, Bayer, Chugai, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Daniela Kaiser: None declared, Dragana Lazarevic: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche, Susan Nielsen: None declared, Farzana Nuruzzaman: None declared, Yosef Uziel: None declared, Nicola Helmus: None declared
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Foeldvari, I., J. Klotsche, O. Kasapcopur, A. Adrovic, M. T. Terreri, R. Cimaz, M. Katsikas, et al. "FRI0466 NO DISEASE PROGRESSION AFTER 36 MONTHS FOLLOW UP IN THE JUVENILE SYSTEMIC SCLERODERMA INCEPTION COHORT." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 830.1–831. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2271.
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Background:Juvenile systemic scleroderma (jSSc) is an orphan disease with a prevalence of 3 in 1 000 000 children. There is rare longitudinal prospective follow up data of patients with jSSc. In the international juvenile systemic scleroderma cohort (JSScC) patients are followed with a standardized assessment prospectively.Objectives:To assess the changes regarding organ involvement pattern and patients related outcomes after 36 months follow up in the JSScC.Methods:Patients diagnosed according the ACR 2013 criteria for systemic sclerosis were included, if they developed the first non-Raynaud symptom before the age of 16 and were under the age of 18 at the time of inclusion. Patients were followed prospectively every 6 months with a standardized assessment.Results:39 patients in the JSScC had 36 months follow up. 80% had a diffuse subtype. 95% of the patients were Caucasian origin. 31 of the patients were female (80%). Mean disease duration at time of inclusion was 3.5 years. Mean age onset of Raynaud’s was 8.8 years and mean age of onset at the first non-Raynaud´s was 9.5 years. Around 30% of the patients were anti-Scl70 positive and none of them anti-centromere positive. The MRSS dropped from the time point of the inclusion into the cohort from 13.9 to 11.8 after 36 months. Pattern of organ involvement did not show any significant change, beside the increase of the nailfold capillary changes from 49% to 73% (p=0.037). No renal crisis occurred. No mortality was observed.They were positive significant changes in the patient related outcomes. The physician global disease activity decreased from 40.0 to 22.1 assessed on a VAS scale of 0 to 100 (p <0.001).Patients global disease activity decreased from 43.3 to 20.4 and patients global disease damage from 45.0 to 21.7 both assessed on a VAS scale of 0 to 100 (p<0.001).Conclusion:After 36 months follow up, we could observe a significant improvement of patient related outcomes and only one significant change in organ pattern involvement. In a mostly diffuse subset patient population this is a very promising result regarding outcome.Supported by the “Joachim Herz Stiftung”Disclosure of Interests:Ivan Foeldvari Consultant of: Novartis, Jens Klotsche: None declared, Ozgur Kasapcopur: None declared, Amra Adrovic: None declared, Maria T. Terreri: None declared, Rolando Cimaz: None declared, Maria Katsikas: None declared, Dana Nemcova: None declared, Maria Jose Santos Speakers bureau: Novartis and Pfizer, Juergen Brunner Grant/research support from: Pfizer, Novartis, Consultant of: Pfizer, Novartis, Abbvie, Roche, BMS, Speakers bureau: Pfizer, Novartis, Abbvie, Roche, BMS, Mikhail Kostik: None declared, Kirsten Minden Consultant of: GlaxoSmithKline, Sanofi, Speakers bureau: Roche, Anjali Patwardhan: None declared, Kathryn Torok: None declared, Nicola Helmus: None declared
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Mathai, Naveen J., Aakaash Sethuraman Venkatesan, Thomas Key, Christopher Wilson, and Khitish Mohanty. "COVID-19 and orthopaedic surgery: evolving strategies and early experience." Bone & Joint Open 1, no. 5 (May 2020): 160–66. http://dx.doi.org/10.1302/2046-3758.15.bjo-2020-0021.r1.
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Aims COVID-19 has changed the practice of orthopaedics across the globe. The medical workforce has dealt with this outbreak with varying strategies and adaptations, which are relevant to its field and to the region. As one of the ‘hotspots’ in the UK , the surgical branch of trauma and orthopaedics need strategies to adapt to the ever-changing landscape of COVID-19. Methods Adapting to the crisis locally involved five operational elements: 1) triaging and workflow of orthopaedic patients; 2) operation theatre feasibility and functioning; 3) conservation of human resources and management of workforce in the department; 4) speciality training and progression; and 5) developing an exit strategy to resume elective work. Two hospitals under our trust were redesignated based on the treatment of COVID-19 patients. Registrar/consultant led telehealth reviews were carried out for early postoperative patients. Workflows for the management of outpatient care and inpatient care were created. We looked into the development of a dedicated operating space to perform the emergency orthopaedic surgeries without symptoms of COVID-19. Between March 23 and April 23, 2020, we have surgically treated 133 patients across both our hospitals in our trust. This mainly included hip fractures and fractures/infection affecting the hand. Conclusion The COVID-19 pandemic is not the first disease outbreak affecting the UK, nor will it be the last. The current crisis has necessitated rapid development of new hospital guidelines and early adaptive strategies in our services. Protocols and directives need to be formalized keeping in mind that COVID-19 will have a long and protracted course until a definitive cure is discovered.
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Mathai, Naveen J., Aakaash Sethuraman Venkatesan, Thomas Key, Christopher Wilson, and Khitish Mohanty. "COVID-19 and orthopaedic surgery: evolving strategies and early experience." Bone & Joint Open 1, no. 5 (May 1, 2020): 160–66. http://dx.doi.org/10.1302/2633-1462.15.bjo-2020-0021.r1.
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Aims COVID-19 has changed the practice of orthopaedics across the globe. The medical workforce has dealt with this outbreak with varying strategies and adaptations, which are relevant to its field and to the region. As one of the ‘hotspots’ in the UK , the surgical branch of trauma and orthopaedics need strategies to adapt to the ever-changing landscape of COVID-19. Methods Adapting to the crisis locally involved five operational elements: 1) triaging and workflow of orthopaedic patients; 2) operation theatre feasibility and functioning; 3) conservation of human resources and management of workforce in the department; 4) speciality training and progression; and 5) developing an exit strategy to resume elective work. Two hospitals under our trust were redesignated based on the treatment of COVID-19 patients. Registrar/consultant led telehealth reviews were carried out for early postoperative patients. Workflows for the management of outpatient care and inpatient care were created. We looked into the development of a dedicated operating space to perform the emergency orthopaedic surgeries without symptoms of COVID-19. Between March 23 and April 23, 2020, we have surgically treated 133 patients across both our hospitals in our trust. This mainly included hip fractures and fractures/infection affecting the hand. Conclusion The COVID-19 pandemic is not the first disease outbreak affecting the UK, nor will it be the last. The current crisis has necessitated rapid development of new hospital guidelines and early adaptive strategies in our services. Protocols and directives need to be formalized keeping in mind that COVID-19 will have a long and protracted course until a definitive cure is discovered.
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Bradley, Peter. "Antimicrobial resistance—is wound care prepared?" Journal of Wound Care 29, no. 12 (December 2, 2020): 738–40. http://dx.doi.org/10.12968/jowc.2020.29.12.738.
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In an Essity-sponsored symposium, entitled ‘Antimicrobial resistance—is wound care prepared?’, four key opinion leaders discussed the difficult journey to managing antimicrobial resistance within wound care at the global and local levels, backed up by the latest research. Peter Bradley summarises the main points they presented at the EWMA 2020 Virtual Conference. This article offers an introduction to the symposium, Antimicrobial resistance—is wound care prepared?, held on 18 November 2020, as part of the EWMA 2020 Virtual Conference. There were four speakers. Claire Kilpatrick, Director, S3 Global and Consultant to the World Health Organization, spoke on ‘Preventing infections and managing antibiotic use—tackling a crisis for the health of nations’. The topic of Karen Ousey, Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield, was ‘Antimicrobial stewardship in wound management—less words more action’. Finally, Hadar Lev-Tov, Assistant Professor, and Irena Pastar, Associate Professor, both of the Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, gave a talk on ‘Silver-resistant bacteria in venous leg ulcers? First results of an exploratory study’.
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McPherson, Danielle, and Jeannette Y. Wick. "Gabapentin: Change is in the Wind." Senior Care Pharmacist 34, no. 8 (September 1, 2019): 490–98. http://dx.doi.org/10.4140/tcp.n.2019.490.
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In the midst of a national opioid crisis, Americans have a heightened awareness of the potential for prescription drugs that can be abused. One drug—gabapentin—is frequently prescribed in long-term care facilities for seizures and postherpetic neuralgia, and its use is a growing concern globally. Approved for two uses, but used off-label for many others, gabapentin can induce euphoria at high doses. In older adults, clinicians prescribe it for seizures, pain, migraine, and aggression associated with dementia, among other things. Gabapentin's rapid onset of action, side effect profile, limited drug-drug interactions, and extensive pharmacokinetic data in renal impairment have made prescribers comfortable using it in older adults. This gabapentinoid—a cousin to the Schedule V drug pregabalin—has seen widespread recreational abuse and has led to its reclassification in the United Kingdom and in several U.S. states. Consultant pharmacists need to be aware that the evidence behind off-label use is scant; withdrawal is likely after as few as three weeks of treatment; and drug diversion is possible, even likely. In addition, it is the tenth-most prescribed medication in the United States.
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Luwaya, Nolundi, Kelley Moult, Diane Jefthas, and Vitima Jere. "Nick Simpson and Vivienne Mentor-Lalu." South African Crime Quarterly, no. 63 (March 30, 2018): 53–60. http://dx.doi.org/10.17159/2413-3108/2018/v0n63a4706.
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Few Capetonians would argue against the claim that the City has been rocked by the current water crisis that many have dubbed the most severe in modern history. Discussions about water saving techniques, membership of the ‘Water Warriors’ club, dinner party comparisons of family daily usage figures, discussion of toilet habits (to flush or not to flush?) and frenzied buying to secure 25-litre water containers have become part of daily life for those of us faced by the imminent (but previously unconscionable) threat of our taps running dry. Even the ‘proudly oily’1 premier of the Western Cape has boasted that she only showers every three days to help beat back Day Zero. But the water crisis has not only raised important questions about residents’ rights to, and responsibility for, the water they use. It has also brought to the surface interesting issues about criminality and crime control, and our individual and collective relationship to water. Stories of violence and incivility at water collection points and in supermarkets have captured attention on social media, and city dwellers have hotly debated the threat of organised crime, laws against rebottling and reselling of municipal water, and the Western Cape government’s Water Disaster Plan, which gives the police and army responsibility for maintaining safety and order at water collection points.
Of course, while questions of water saving, risk and safety feel quite new to many Capetonians, scholars, activists and policymakers (including criminologists) have been writing about these issues for much longer. The Centre for Law and Society approached two scholars/activists to discuss the water crisis and its impact on questions of vulnerability, risk and security. Nick Simpson, an environmental and human development consultant (and post-doctoral scholar at the University of Cape Town), discussed questions of criminology in the age of the Anthropocene, and Vivienne Mentor-Lalu, a researcher/facilitator for the Women and Democracy Initiative at the Dullah Omar Institute at the University of the Western Cape, spoke to us about the gendered impact of the drought. Nolundi Luwaya, Kelley Moult, Diane Jefthas and Vitima Jere contributed to this piece.
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Connell, Carol M., and Christine Lemyze. "The growth oxymoron: strategic execution." Strategic Direction 35, no. 6 (May 20, 2019): 1–4. http://dx.doi.org/10.1108/sd-09-2018-0194.
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Purpose The purpose of this paper is to present a viewpoint on aligning strategy and execution to produce superior business results. Design/methodology/approach The paper examines the long-term financials of the top ten growers to reveal companies that have continued to grow in good economic times and bad, including the Great Recession. While some companies dug deeper into their core businesses during the financial crisis, others continued to innovate. Findings Where companies continued to focus on strategy execution, they were rewarded, for example, Amazon’s compound annual growth rate for the ten-year period that included the financial crisis was 36.45 per cent; in the past three years, Amazon’s compound annual growth rate (CAGR) has been 56.76 per cent. Most of the top ten long-term growers are headed by the same founder/entrepreneur. Research limitations/implications Look beyond the past three years for models of successful strategy execution. Practical implications For long-term company leaders, entrepreneurs, or turnaround experts, strategic execution is no oxymoron, but a requirement for growth and, ultimately, their unique responsibility. Social implications The paper identifies three major focus areas for strategy teams and company leadership: 1. customer centricity and strategy execution; 2. learning from survivors; and 3. rethinking capabilities and talent. Originality/value As a professor of strategic management and as a consultant to organizations on strategy and marketing transformation, we have focused on the activities that are necessary for leaders to create effective strategy and to execute successfully. We have also been responsible for equipping the larger teams of strategy professionals (and future strategy professionals) who support these leaders with the approaches, the methods, and the tools necessary to plan effectively, to assess effectiveness, and to correct problems in strategy and execution. We bring that perspective to this viewpoint paper.
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Kousteni, Margarita, John Cousins, Ajay Mansingh, Maja Elia, Yumnah Ras, Mercedes Chavarri, Marilia Gougoulaki, and Imo Akande. "Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)." BJPsych Open 7, S1 (June 2021): S202. http://dx.doi.org/10.1192/bjo.2021.541.
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AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.
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Roseveare, Chris. "Editorial Volume 15 Issue 3." Acute Medicine Journal 15, no. 3 (July 1, 2016): 110. http://dx.doi.org/10.52964/amja.0619.
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Acute Medicine is full of ‘C-words’ – the Nursing and Midwifery Council’s ‘Six Cs’ (Care, Compassion, Competence, Commitment, Courage and Competence) are as relevant on the AMU as anywhere else in the Health Service; acute physicians would probably also include co-ordination, collaboration and crisis management, as winter looms before us. Dan Beckett’s paper from Forth Valley in Scotland, suggests another word that should be added to the list. As we strive to design sustainable rotas which span 7 days and comply with European work-time directives it is understandable that continuity often falls by the wayside, particularly in smaller Units. The transition from the acute medicine team to an in-patient specialist ward will usually, and appropriately, require hand-over of care. However, as described in this paper, patients who remain within the AMU may find that they see a different consultant each day. Moving to a model whereby patients in the AMU remained under the care of the admitting consultant was shown to shorten their AMU length of stay, facilitating transfer to the appropriate in-patient team, although not increasing the proportion of patients discharged directly from the unit. The authors proposed that this latter finding related to changes in the skill mix of the consultant team covering the AMU, demonstrating the complexity of the challenges we face. It would have been interesting to study the impact on patient satisfaction – as well as consultant job satisfaction – from this new model; my own, purely anecdotal data, suggests both may be considerably improved. This month’s case report selection illustrates some interesting clinical conundrums. Lower limb cellulitis is a common reason for presentation to the acute medical, or ambulatory care unit; however, when the rash or erythema is bilateral, there is often an alternative diagnosis. In the case described by Cranga and colleagues, antibiotics turned out be the cause (rather than the solution) to the problem. Early liaison with the dermatology team enabled the diagnosis of acute generalized erythematous pustulosis to be made, and resolution of the condition followed discontinuation of antibiotics. The authors include a useful table to support clinicians in making this (albeit rare) diagnosis. Emily McNicholas reminds us of the importance of a collateral history – it is not hard to see how a patient with fever, confusion and incontinence might be labelled as having a urinary tract infection; the retrospective story of a cocktail stick in the throat prior to onset of the symptoms might have pointed to the correct diagnosis is this had been obtained at the time of admission. This case also shows the dangers of separation of Emergency Department notes from those of hospital in-patients, even within the same organization – a problem which will be familiar to many UK readers of this journal. Patients with frailty represent a significant proportion of admissions to the acute medical take and often provide considerable management challenges. Natalie Offord and colleagues from the British Geriatric Society have described the development of the Frailsafe collaborative which clearly provides a major step forward. At the other end of the age spectrum, adolescents and young adults (AYAs) may represent a different kind of challenge for the acute medicine team. Some of the key messages from the recent Royal College of Physicians’ Acute Care Toolkit for AYAs are summarized in the article on p157. Anyone who is involved in managing this group of patients is recommended to read this article, and please look out for the link to a survey about this at the end of the article.
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Groseanu, L., A. Balanescu, V. Bojinca, D. Opris-Belinski, I. Saulescu, D. Mazilu, S. Daia-Iliescu, et al. "AB0580 GENDER DIFFERENCES IN SYSTEMIC SCLEROSIS- IMPACT ON DISEASE PHENOTYPE AND PROGNOSIS." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1586.1–1587. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3350.
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Background:The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results.Objectives:To evaluated sex influence on disease characteristics at baseline and then to estimate the effects of sex on disease progression and survival.Methods:We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096. 173 patients were analysed (26 males).The severity of organ system involvement was defined as described previously (1).Results:Males were significantly older at symptom onset (p=0.007) and at first center visit (p=0.009). There were no differences regarding disease duration at first visit or the interval between the onset of Raynaud syndrome and other non-Raynaud manifestations (p=0.06). Male patients were significantly more likely to have ever smoked (p<0.001), males more often had severe or end-stage peripheral vascular involvement (p=0.01). Modified Rodnan skin score (mRSS) was significantly higher in males (p=0.004). We found no difference regarding musculoarticular involvement, except for digital contractures (p=0.001) and tendon friction rubs (p=0,044). Males more often had interstitial lung disease (ILD) (p=0.013) which was also more frequently severe or end-stage (p = 0.003). Cardiac involvement was more common in males: pulmonary hypertension (PAH) (p = 0.018), arrhytmias (p=0.012), left ventricle ejection fraction<45% (p=0.014). The frequency of scleroderma renal crisis (SRC) was higher in males (p=0.025). Gastrointestinal involvement did not differ between groups EScSG (European Scleroderma Study Group) disease activity scores were higher in males (p=0.001). The isolated presence of antitopoisomerase-1 or anticentromere antibodies did not differ between groups. Mortality rate was similar between sexes, although male sex is a independent predictor for the death associated with ILD, SRC, arrythmiasIn multivariate analysis, male sex was independently associated with a higher risk of diffuse cutaneous subtype (OR: 1.56, (1.35 to 1.84); p<0.001), a higher frequency of severe vascular disease (OR: 1.38 (1.11 to 1.67); p<0.001), severe digital contractures (OR:1.92(1.68 to 2,42); p<0.001), interstitial lung disease OR: 1.22 (0.9 to 1.47); p<0.001), severe heart involvement (OR: 1.56 (1.22 to 2,1); p<0.001) and SRC (OR: 3.31 (1.87 to 5620); p<0.003). In the longitudinal analysis, after a mean follow-up of 7.2 (±2.6) years, male sex was predictive of new onset of scleroderma renal crisis (HR: 3.66 (1.82 to 4.86); p=0.006) and heart failure (HR: 1.9 (1.36 to 3.18); p=0.01).Conclusion:In essence, the disease prophyle in females is that of younger age of onset, longer disease duration at first center visit, less severe peripheral vascular involvement, the most frequent cause of death being PAH. In contrast, males are older at onset, present earlier in their disease, have dcSSc, more severe peripheral vascular disease, higher mRSS, more frequent and severe ILD, more frequent heart involvement, higher risk of PAH and SRC, the most common cause of death being ILD. These results raise the point of including sex in the management and the decision-making process.References:[1]Peoples C, Medsger TA Jr, Lucas M et al Gender differences in systemic sclerosis: relationship to clinical features, serologic status and outcomes.J Scleroderma Relat Disord. 2016;1(2):177–240Disclosure of Interests:Laura Groseanu Speakers bureau: novartis, eli-lilly, ucb, pfizer,sandoz, Andra Balanescu Consultant of: pfizer, Speakers bureau: Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, UCB, Violeta Bojinca Speakers bureau: Eli-Lilly, Novartis, Pfizer, Daniela Opris-Belinski Speakers bureau: Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Ioana Saulescu Speakers bureau: Eli-Lilly, Pfizer, Diana Mazilu: None declared, Sanziana Daia-Iliescu Speakers bureau: sandoz, Andreea Borangiu: None declared, Florian Berghea Paid instructor for: abbvie, Speakers bureau: gideon richter, egis, novartis,ucb, cosmin-laurentiu constantinescu: None declared, CLAUDIA COBILINSCHI Speakers bureau: novartis, Maria Magdalena Negru: None declared, mihai abobului Speakers bureau: gideon richter, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz
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Velez, Sophia, Michael Neubert, and Daphne Halkias. "Banking Finance Experts Consensus on Compliance in US Bank Holding Companies: An e-Delphi Study." Journal of Risk and Financial Management 13, no. 2 (February 5, 2020): 28. http://dx.doi.org/10.3390/jrfm13020028.
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Compliance measures emphasized in the Dodd-Frank Bill 2010, Section 165 is a response to the 2008 financial crisis, that requires large banks to maintain a minimum capital ratio. The Federal Reserve Bank (Fed) regulates capital of Bank Holding Companies (BHC) through compliance Supervisory Capital Assessment Program (SCAP) 2009 and Comprehensive Capital Adequacy Review (CCAR) 2011 annual stress test of capital. The Fed imposed a minimum capital ratio of 8% that has derailed the risk management objective of capital adequacy, as bank managers are forced to take on more risk to meet the capital ratio. This study concerns senior manager practices that can be effective in meeting compliance requirements posed by the Fed for BHCs. Through a qualitative e-Delphi study, 10 banking finance experts were convened to build consensus on senior manager’s practices that can be effective in meeting compliance requirements. Data were collected from three electronic questionnaires submitted through Qualtrics. Data were analyzed using theoretical triangulation, coding, and thematic analysis. Four important considerations were identified that could bolster compliance measures effectiveness: (a) emphasis placed on understanding regulatory consultant compliance, (b) maintenance of effective and independent compliance align to organizational objectives, (c) clear definition of data source for compliance analytics. These considerations of compliance practices may help senior bank managers reduce risky behaviors and investments that cause significant bank losses.