Right VI palsy revealing nasopharyngeal cancer (UCNT)

VI paralysis is a frequent and classic pathology in the clinical consultation of ophthalmology. The main difficulty is the diagnostic process (for the etiology). In young adults, be aware of the possibility of a tumor with the correlation of rapid imaging. UCNT is frequent in Morocco, its neurological symptoms are misleading because we do not always think of examining the nasopharynx properly in the event of damage to the cranial pairs. Improving the prognosis for this cancer requires early diagnosis.

Rare Tumors in Children and Adolescents – the STEP Working Groupʼs Evolution to a Prospective Registry

Background Very rare tumors (VRT) in children and adolescents have such a low incidence that until recently, they have not been integrated into the clinical and scientific network of pediatric oncology. Data is very limited and consistent treatment strategies are missing. Thus, VRTs are classic orphan diseases. To counteract this problem, the Arbeitsgemeinschaft für Seltene Tumorerkrankungen in der Pädiatrie (STEP) was founded. Here we report on patient recruitment during the first 10 years. Patients Patients aged up to 18 years and not included in any other clinical trial or GPOH registry were included in this analysis. Methods Data was collected from 2008 to 2018 by means of a standardized form. The recorded diagnoses were descriptively analyzed focusing on histology, localization, and year of report. Results A total of 623 patients with VRTs were registered. During 2008–2014, the annual number of registrations was around 40 and is around 90 since 2015. Most frequent diagnoses included tumors of the skin (n=150), tumors of the gastrointestinal tract (n=102), tumors of the gonads (n=77), the ENT region (n=68), and miscellaneous tumors (n=107). Discussion With the establishment of central structures for clinical consultation and documentation of VRTs, the number of registrations increased. Comprehensively, VRTs are as common as other classic pediatric oncology tumors, but extremely heterogeneous in terms of localization, histology, and prognosis. By a centralized and complete registration and analysis of VRTs, also in collaboration with international partners, it is possible to develop treatment strategies and thus greatly increase treatment quality.

635 Expectations and Concerns of Patients Attending a Spinal Outpatient Clinic

Aim Identifying expectations and concerns of patients is vital during clinical consultation in patient-centred healthcare systems. Most spinal surgery is elective and focussed on improving quality of life. Understanding what patients want from treatment at baseline may improve experience and outcomes. Method New patient data from the caseload of a single orthopaedic spinal surgeon (from April 2012-18) was analysed with expectations and concerns reported in the outpatient clinic letter (standard practice for surgeon). Results Of 940 patients (498 NHS, 442 private), mean age was 58.3 with 46.0% male and 54.0% female. Nearly 1-in-6 patients underwent previous surgery. The most common expectation was ‘reduce pain’ (41.8%), followed by diagnosis (23.0%), treatment options (13.5%), unsure (10.5%). The most common concern was ‘continuation/worsening of pain’ (27.0%), followed by loss of function (15.9%), work-related (8.3%), permanent disability (7.8%). NHS patients were significantly more unsure of expectations (19.7% vs 4.5%, p<.001) and less frequently raised concerns (39.0% vs 18.8%, p<.001). NHS patients had significantly worse Oswestry Disability Index (ODI) scores (46.8% vs 42.0% p<.001), were more depressed (PHQ-9: 11.5 vs 8.9, p<.001) and anxious (GAD-7: 8.2 vs 5.9, p<.001). Private patients were significantly more likely to report problems sleeping (79.4% vs 51.0%, p<.001). Patients concerned about permanent disability had significantly worse ODI (51.0% vs 42.7%, p<.001), PHQ-9 (12.6 vs 10.2 p=.013) and GAD-7 (9.0 vs 7.1, p=.017) scores. Conclusions This study identified patient expectations and concerns in spinal outpatient clinic in both healthcare sectors. Future work should explore these findings in context with clinical outcome.

Friend or Frenotomy: A Single Institution’s Experience With Ankyloglossia

Introduction/AimAnkyloglossia, or ‘tongue-tie’, is a common congenital anomaly in which a short lingual frenulum or genioglossus muscle restricts tongue movement. Ankyloglossia can be graded from 1 (most severe) to 4 (least severe). The effects of ankyloglossia can include breastfeeding and articulation issues; however, many infants will have no symptoms or developmental problems. The surgical intervention for ankyloglossia is frenotomy. This can be performed in the outpatient setting in small infants. Ankyloglossia referrals in neonates and small infants necessitate an urgent referral to the ear nose and throat (ENT) clinic in order to facilitate breast feeding and weight gain. We sought to analyse the ankyloglossia service in a district general hospital setting from referral to outpatient clinic. MethodsWe retrospectively analysed a consecutive cohort of babies referred to the Ear Nose and Throat service for consideration of frenotomy over an 18 month period, We analysed data from referral including demographics and clinical information, we recorded information from the clinical consultation and procedure details if frenotomy was performed.ResultsBetween 1 January 2019 and 31 January 2021 referrals were made for consideration of frenotomy, all appointments were seen within 2 weeks. 55.3% of referrals were sent from public health nurses, 25.5% from primary care, 10.6% from lactation consultants and 8.5% from paediatric consultants. Of 47 referrals, a frenotomy was performed in 30 babies. All frenotomies were performed without complications.ConclusionInformation on ankyloglossia is varied and available information is conflicting, without any clear standardised guideline or treatment algorithm. Referral indications can be unclear and result in unnecessary clinic appointments in an already heavily burdened service. Frenotomy can be performed safely by a trained clinician in an outpatient setting with minimal equipment.

Digital Consumer Health: Negotiating Multiple Voices in the Clinical Consultation

In this paper, we explore what may happen when people who are ostensibly “well” bring data from digital self-tracking technologies to medical consultations. On the basis of a fictional case narrative, we explore how multiple “voices”, in a Bakhtinian sense of the term, inscribed in the self-tracking devices are activated, negotiated, evaluated and re-imagined in the context of care. The digital metrics “speak” precision, objectivity and urgency in ways that challenge conventional, normative understandings of doctors’ professional role and the patient-doctor relationship.Our theorizing is firmly grounded in our professional experience and informed by recent research on self-tracking, Mol’s research on the ways in which technology has become integral to medical care, Bakhtinian theory and medical professionalism, and it contributes to current professional debates regarding medical overuse and its potential to harm patients. Further research is needed to illuminate the consequences of digital self-tracking technologies for patient-professional consultations in practice.

Developing a model of post-workshop consultation for clinicians learning to deliver Cognitive Processing Therapy for posttraumatic stress disorder

Best practice in training clinicians to deliver evidence-based psychotherapies includes workshop attendance followed by post-workshop consultation. Although previous research highlights the importance of consultation, little is known about what makes for effective consultation, and no model of clinical consultation currently exists. The primary aims of this study were to identify the primary elements of consultation, and develop a model of consultation in a sample of clinicians learning to deliver Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2014), an evidence-based psychotherapy for posttraumatic stress disorder. The study was conducted from a realist perspective, a paradigm that is particularly useful for theory building. The study involved the participation of mental health clinicians (N = 41) who attended one of five CPT workshops, and CPT consultants (N = 6) who provided the clinicians with post-workshop consultation for six months following the workshop. Thirty audio recorded consultation calls were randomly selected and transcribed. The data was coded and analyzed using thematic analysis. The kappa statistic measuring inter-rater reliability was .80. The following contextual factors were identified: access to group support, clinicians joining late, clinicians not having content to discuss, study participation, and technological disruptions. Knowledge consolidation and case conceptualization were identified as the overarching functions of consultation. The remaining elements of consultation were classified into the following themes: Organization, Asking for Help, Directive Instruction, Non-Directive Instruction, and Provision of Feedback. Two hypothesized mechanisms of consultation, reflection and connectedness, wereidentified. A comprehensive model positing how consultation works was presented. Additionally, three sets of context-mechanism-outcome configurations were presented. The model of consultation was compared to the model of clinical supervision proposed by Milne and colleagues (2008). Finally, the usefulness of Kolb’s (1984) model of experiential learning was explored as a framework for understanding the learning that occurs during clinical consultation. Based on the study’s findings, several recommendations for clinical practice were made. An important next step is to test the proposed theory, and to assess the relationship between the use of various elements of consultation and the development of proficiency in delivering CPT.

Developing a model of post-workshop consultation for clinicians learning to deliver Cognitive Processing Therapy for posttraumatic stress disorder

Best practice in training clinicians to deliver evidence-based psychotherapies includes workshop attendance followed by post-workshop consultation. Although previous research highlights the importance of consultation, little is known about what makes for effective consultation, and no model of clinical consultation currently exists. The primary aims of this study were to identify the primary elements of consultation, and develop a model of consultation in a sample of clinicians learning to deliver Cognitive Processing Therapy (CPT; Resick, Monson, & Chard, 2014), an evidence-based psychotherapy for posttraumatic stress disorder. The study was conducted from a realist perspective, a paradigm that is particularly useful for theory building. The study involved the participation of mental health clinicians (N = 41) who attended one of five CPT workshops, and CPT consultants (N = 6) who provided the clinicians with post-workshop consultation for six months following the workshop. Thirty audio recorded consultation calls were randomly selected and transcribed. The data was coded and analyzed using thematic analysis. The kappa statistic measuring inter-rater reliability was .80. The following contextual factors were identified: access to group support, clinicians joining late, clinicians not having content to discuss, study participation, and technological disruptions. Knowledge consolidation and case conceptualization were identified as the overarching functions of consultation. The remaining elements of consultation were classified into the following themes: Organization, Asking for Help, Directive Instruction, Non-Directive Instruction, and Provision of Feedback. Two hypothesized mechanisms of consultation, reflection and connectedness, wereidentified. A comprehensive model positing how consultation works was presented. Additionally, three sets of context-mechanism-outcome configurations were presented. The model of consultation was compared to the model of clinical supervision proposed by Milne and colleagues (2008). Finally, the usefulness of Kolb’s (1984) model of experiential learning was explored as a framework for understanding the learning that occurs during clinical consultation. Based on the study’s findings, several recommendations for clinical practice were made. An important next step is to test the proposed theory, and to assess the relationship between the use of various elements of consultation and the development of proficiency in delivering CPT.

A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for posttraumatic stress disorder

Background: Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. Methods: The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings. Discussion: Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation. Trial registration: ClinicalTrials.gov: NCT01861769