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PubMed2005

[Gerontopsychiatric problems in a consultation-liaison practice].

UNLABELLED: The most effective way for the diagnosing and the treatment of psychopathological symptoms appearing in non-psychiatric hospitalized patients is the utilization of consultation-liaison psychiatry. With the increasing number of the elderly patients, number of appearing gerontopsychiatric problems in consultation work is also growing. AIM: We have studied among the patients of a consultation-liaison service the problems which led to the psychiatric consultations, the diagnoses which were set up, the concomitant somatic disorders and the treatment recommendations. METHOD: We have retrospectively studied the data of the patients in the consultation-liaison service of St. László Hospital. RESULTS: 77% of the consultations were asked from internal medicine. Most frequent reason of the requests were the presence of any psychiatric symptom, but unexplained somatic complains were also common. Gerontopsychiatric problems were most frequently associated to cardiovascular disorders. Demencia and delirium were the most frequent diagnoses. The rate of affective disorders was higher than reported in the literature. CONCLUSIONS: Consultations were most frequently asked for non-compliance in patients with demencia, and for unexplained somatic complain in affective disorders. Most frequent reason of psychiatric referrals was symptoms of delirium. Authors try to explain these results in accordance with the literature.

Aged↗
PubMed2006

Patients' experiences of GP consultations for psychological problems: a qualitative study.

BACKGROUND: The vast majority of patients with psychological problems are seen solely by their GP, but little is known about patients' perspectives regarding the variety of consultation skills that may be used in routine GP consultations with these patients. AIM: To identify which aspects of GP consultations patients presenting with psychological problems experience as helpful or unhelpful. DESIGN: Qualitative study. SETTING: Nine general practices in north central London. METHOD: Twenty patients, who had discussed psychological problems as a significant part of their index GP consultation, were asked in detail using the tape-assisted recall (TAR) method, about aspects of the consultation they had experienced as helpful or unhelpful. RESULTS: All patients described how the relationship with the GP helped or hindered them in discussing their problems; this was central to their experience of the consultation. An underlying attitude of genuine interest and empathy, within a continuing relationship, was highly valued. Patients also described how the GP helped them make sense of, or resolve their problems, and supported their efforts to change. CONCLUSION: These patient accounts suggest that routine GP consultations for psychological problems can have a powerful impact, at least short-term. The GP role in providing a safe place where patients feel they are listened to and understood should not be underestimated, particularly in the mental health context. Further research is required to investigate the longer-term impact of different GP behaviours on patient health outcomes. The TAR method has potential applications in primary care research and in the training of GPs and other health professionals.

Adult↗
PubMed2006

[Progress of the Laboratory Consultation Office in Kyoto Prefectural University Hospital].

In an attempt to assist the clinical physicians at the outpatient clinics in Kyoto Prefectural University Hospital, we opened the laboratory consultation office in January 2005. This office is staffed by one medical technologist from 9 am to 4 pm on weekdays. The technologist shows the laboratory examination result of respective patient, and then explains the significance of reference interval using the personal computer. Additional explanation such about the mechanism of abnormal result or the general interpretation of diagnostic tests is also performed according to the patients' demands. Whereas, as the major premise, the consulting technologist never comments to the patients on the clinical relevance between their laboratory results and their own disease courses. Until March 2006, 1,430 outpatients have visited the office in total, resulting in 6.1 patients/day as mean value. Almost all of the visitors (97.9%) wanted to listen to the meaning of liver function test, which was followed by renal function test (95.3%). Consulting time required for respective patient has been quite variable from 10 to 120 minutes (30 minutes/patient as mean). The questionnaire survey after consultation revealed that all of the visitors felt satisfactory for consultation, and wanted to revisit to our laboratory consultation office. We believe that the laboratory consultation office contributes as a new medical service of our hospital to outpatients.

Ambulatory Care↗
PubMed1991

[An analysis of informal veterinary consultations during radio programmes].

A sample of informal consultations based on letters which were sent to a radio programme in which the theme was informal veterinary consultations were analysed. The animal-owner profile, the identification of animals involved and the need which motivated owners to seek such consultations were investigated. The results indicated that the most typical animal owner to participate in programmes of this nature was an adult woman living in the country and the most common animal involved was an intact male dog. The most common area of concern was ethological of nature. Behavioural problems were the most common ethological problem, followed by management and care. The significance of this study for the veterinarian is probably that it recognises the role and importance of informal consultations, that deficiencies in formal consultations are indicated and that it emphasises the need of readily available knowledge of ethology, that informal consultations are unsuitable for serious cases, and that informal consultations give further insight into human-animal interaction from a veterinary perspective.

Age Factors↗
PubMed1991

Time spent in state-recommended functions by consultant dietitians in Wisconsin skilled nursing facilities.

In this study we determined how consultant dietitians working in Wisconsin skilled nursing facilities distributed their time among contracted duties. At the time of the study, the 400 skilled nursing facilities in Wisconsin employed 160 consultant dietitians. Of these, 135 consultant dietitians were eligible to participate in the study. A mailed questionnaire was used to collect data on educational background, experience, and actual time spent in state-recommended functions, additional resident-care functions, and additional non-resident-care functions. Completed, usable questionnaires were returned by 65 (48%) of the 135 consultant dietitians. Data were analyzed statistically and presented as medians, means, and standard deviations. Mean time (minutes) consultant dietitians spent per resident admission activity was as follows: data collection, 31.3; care planning, 28.9; resident counseling, 18.5; medical record review, 17.7; discharge referral, 15.4. Mean time (minutes) consultant dietitians spent per month in other activities was as follows: facility evaluation, 75.3; student training, 120; allied staff training, 38.7; foodservice staff training, 46.8; technician training, 128; menu planning, 76.9; diet manual review, 21.6; quality assurance programs, 31.8; quality assurance audits, 34; report preparation for facility administrator, 33.4; and policy development, 32.8. Mean times reported in this study may be used as time guidelines by the state of Wisconsin for evaluating how skilled nursing facilities contract for services of consultant dietitians. Other state and federal regulatory agencies could use the time guidelines for comparison and verification until future studies provide more data on time standards for state-recommended functions, additional resident-care functions, and additional non-resident-care functions.

Consultants↗
PubMedDate not supplied

Consultations from a family medicine inpatient service.

The pattern and rate of consultation from a family practice residency program inpatient service were examined. The most frequently consulted medical specialty was cardiology; the most frequently consulted surgical specialty was general surgery. The overall consultation rate was 50%. The consultation rates for the most frequent discharge diagnoses were examined. Pediatric admissions were less likely to received consultations than adult or geriatric admissions. The results of this study suggest that family physicians are able to manage most of their hospitalized patients without consultation.

Diagnosis↗
PubMed1986

Domiciliary consultation--who benefits?

A survey was conducted of the domiciliary consultation service provided in one health district in order to identify the pattern of referral by specialty, the reasons for the consultation and its outcome and to determine whether the service is realizing its original objectives.The district domiciliary consultation service was used in the majority of cases as an initial means of assessment for elderly patients with chronic disease. The majority of patients were kept out of hospital but responsibility for their care was usually transferred to the consultant. The domiciliary consultation service was rarely used as a means for joint consultation between family doctor and hospital specialist. To facilitate the care of patients in the community, it is suggested that domiciliary visiting should be incorporated into a consultant's NHS contract and the present regulations abandoned.

Adult↗
PubMed1986

Human rights consultation: a 12-year experience of a pediatric bioethics committee.

For many years there has been a committee at the Children's Hospital of Pittsburgh to review research proposals to assure that the rights of children are protected. In 1974, its composition was changed and its mission broadened to include consultation and discussion of ethical issues in clinical care. The committee is called the Human Rights Committee to reflect this mission. Medical ethical consultations are performed by rotating on-call teams consisting of a physician and a nonphysician who are members of the committee. Selected cases from 48 consultations are presented to demonstrate the process and to illustrate some of the questions that were addressed. The clinical diagnoses were varied, but the commonest were congenital malformations. The most frequent reason for consultation was to question the advisability of assisted ventilation (27 cases), but other reasons concerned definitive surgery, intravenous hyperalimentation, cardiopulmonary resuscitation, and tracheostomy. Consultations are always optional and advisory. The recommendations of the consultation team are subsequently reviewed by the entire Human Rights Committee. The service has been well received by the medical staff. This method has some of the advantages of both the hospital ethics committee and the single consultant. Therefore, it should be considered when planning how to deal with these important problems.

Acute Disease↗
PubMed1979

Patients' reactions to psychiatric consultation.

Physicians are often concerned that patients will resent a request for psychiatric consultation. To investigate this problem, 60 patients undergoing psychiatric consultation in a general hospital were inverviewed 24 hours after the consultation. Nearly two thirds of these patients believed that the consultation was beneficial. Patients' attitudes were independent of their demographic characteristics, reason for referral, and hospital service involved. Patients with long-term illnesses more often had positive attitudes than patients with short-term illnesses. Patients who were initially hostile or ambivalent usually had positive attitudes 24 hours later. Substance abusers and patients who denied clearly recognizable psychiatric disorders often did not value the consultation. Even so, their physicians frequently believed that the consultation was useful. We attribute the positive attitudes of patients in our study largely to the referring physicians' preparing them for psychiatric consultation.

Adolescent↗
PubMed1978

Perioperative diabetic consultation: a plead for improved training.

To determine the clinical and educational impact of an academic general internal medicine consultation service, the investigators selected as a model the perioperative management of diabetes mellitus. They analyzed 17 consultative episodes over two years by retrospective medical record review to identify patterns and shortcomings. Most patients were elderly black females with maturity-onset diabetes mellitus exhibiting numerous past diabetic complications and other active general medical problems. Major findings included common failure to define the consultation purpose or document adequately follow-up visits, incomplete professional adherence to published guidelines for perioperative diabetic management, and correlation between failure to document the consultant's own physical examination and failure to reach new conclusions. Median cost for consultant-recommended tests was $179 (range $82 to $552) without clear linkage between medical care process and outcome. Consultative skills must be taught more effectively if medical consultations are to have maximal impact.

Adult↗
PubMed1982

Consultations with attorneys as a funding source for drug information centers.

The provision of legal consultations to attorneys as a method of generating income for a drug information center is described. The center established a formal, fee-based consultation service for lawyers after receiving several calls a month on a regular basis. During a six-month trial period, approximately 60% of the calls from lawyers were simple requests for information, such as the identification of a drug, drug dosage, or product availability. The remainder of the calls required formal written consultations, which had to be individualized to meet the attorneys' needs. The average length of these consultations was 2-3 pages including patient data, the request, response, conclusions, and 10-15 citations from the medical/pharmaceutical literature. No fees were charged for the requests that could be handled on the phone. For the preparation of a written consultation with references, the lawyers were billed +100/hr. Conferences with attorneys before preparing a request were also billed at +100/hr. If a deposition was required after the consultation services in the state's law journals and various legal publications. The majority of the attorneys who used the service indicated that they would probably use it again. The center found the provision of legal consultations to attorneys to be an effective mechanism for generating additional revenue.

Drug Information Services↗
PubMed1995

From the surgery to the surgeon: does deprivation influence consultation and operation rates?

BACKGROUND: Concern about equity of access to health care has increased since the health care reforms implemented in the 1990s. Access to specialist health care is controlled by general practitioners; assessing and ensuring equity should therefore begin in general practice. AIM: This study set out to determine whether there are socioeconomic differences in the relationship between expressed need for possible surgical intervention (consulting a general practitioner) and surgical provision. METHOD: Information on the social class distribution of expressed need was obtained from the third national morbidity survey (1981-82) for 140,049 patients consulting a general practitioner. The conditions examined were: inguinal hernia, gallstones, tonsillitis, varicose veins, cataract and osteoarthritis. This expressed need was compared with the appropriate operation for all residents of North East Thames Regional Health Authority from January 1991 to July 1992 classified, according to area of residence, by the Townsend deprivation score. RESULTS: The relationship between expressed need and provision by deprivation was concordant for some conditions, but discordant for others. For cataract and tonsillitis, there was an inverse U pattern between increasing deprivation and both patient consultation and operation ratios. For varicose veins, deprivation was associated with higher patient consultation and operation ratios. For hernia, gallstones and osteoarthritis, consultations increased with deprivation, but operation ratios were either unrelated to deprivation scores (hernia and gallstones) or decreased by deprivation score (hip operations). CONCLUSION: There are marked socioeconomic differences in consultation ratios for these common conditions which may not be matched by operation ratios. For discordant comparisons, people in the most deprived quartiles were generally least likely to receive surgery despite being most likely to consult a general practitioner with symptoms. If validated, these findings have important implications for general practice and service providers.

Adult↗
PubMed1994

Initial consultations in hearing aid clinics in Australia.

Fifty initial consultations in government hearing aid clinics were audiotape recorded and analyzed to study the behavior of audiologists and clients in the initial stages of hearing aid rehabilitation. Consultations averaged 34 minutes and showed a four-stage clinical routine in which clients appeared largely passive. Hearing aid fitting was initiated in 48 (96%) consultations. The consultations of individual audiologists differed significantly in total time, proportion of consultation time in which talk occurred, proportion of consultation time in which talk occurred, proportion of consultation time devoted to hearing assessment, and the number of clients' direct requests for information. Individual audiologists appeared to have one of two general patterns in hearing aid prescription. The study indicates a need for the further study of audiologist behavior and the relationship of that behavior to hearing aid rehabilitation outcomes such as client satisfaction and degree of hearing aid use.

Adult↗
PubMed1996

Indications and immediate patient outcomes of pathology intraoperative consultations. College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group Study.

OBJECTIVE: To evaluate the reasons (indications) for and immediate intraoperative surgical results (outcomes) associated with pathology intraoperative consultation. DESIGN: In 1992 and 1993, surgeons collaborated with pathologists in 472 voluntarily participating institutions from the United States (462), Canada (7), Australia (2), and New Zealand (1) in a study jointly sponsored by the College of American Pathologists and the Centers for Disease Control and Prevention. Pathologists selected 20 consecutive intraoperative consultations and assembled a cover letter, a checklist questionnaire, and a copy of the corresponding surgical pathology report, all of which were sent to the surgeon(s) for retrospective evaluation. PARTICIPANTS: The study was distributed to participants in the College of American Pathologists voluntary Q-Probes quality improvement and Surgical Pathology Performance Improvement programs and to Canadian and Australian hospitals with more than 200 beds. RESULTS: Evaluation of 9164 cases established the five most common indications for intraoperative consultation: (1) establish or confirm diagnosis to determine type or extent of operation (51%), (2) confirm adequacy of margins (16%), (3) confirm nature of tissue to direct sampling for immediate culture or other laboratory study (10%), (4) expedite obtaining diagnosis to inform family or patient (8%), and (5) confirm sufficient tissue submitted to secure diagnosis in permanent section (8%). The information provided by the intraoperative consultation resulted in changed surgical procedures that were either modified, terminated, or newly initiated in 47%, 30%, 6%, 9%, and 28% of cases, corresponding respectively to each of the above five common indications. Rarely cited reasons for intraoperative consultation were to expedite obtaining diagnosis for surgeon's knowledge (3%), to facilitate patient management, other professional communication or discharge planning prior to permanent section availability (3%), academic protocol (< 1%), and consultation not needed or no reason for request (< 1%). CONCLUSIONS: This multi-institutional, interdisciplinary database confirms that pathology intraoperative consultations, regardless of the initial indications, influence immediate patient care decisions, resulting in changed surgical procedures in an average of 39% of all operative cases.

Australia↗
PubMed1998

[Clinical and epidemiological analysis of 1,451 pediatric surgery consultations in a third level hospital referred from the primary health care sector].

OBJECTIVE: The aim of this study was to determine the pediatric surgery demands in a third level hospital due to referrals from the primary health care sector in order to better plan the work and continuing education programs. PATIENTS AND METHODS: The total number of patients (1,451) consulting a service of pediatric surgery for the first time and referred from the primary care sector during a twelve month period were studied. RESULTS: A total number of 1,451 children, with a maximum age of 14 years consulted. The assistential pressure was 22.01 consultations/pediatrician/day in one year. Consultations by children older than 7 years of age comprised 31.42% of the total. As for the distribution of these consultations, 61.26% were with a previous appointment, 38.74% were remitted to the second level. The most frequent reasons for consultations were inguinal hernia and hydrocele (30.46% of the cases), followed by phimosis (28.8%), undescended testis (8.2%) and skin neoplasms (5.78%). CONCLUSIONS: The demands of pediatric surgery consultations referred from the primary health care sector is very important. It is necessary to adapt the continuing education programs so that pediatric residents and primary medicine physicians are more aware of the surgical pathologies that are most frequently found in primary care centers and to decrease the assistential pressure of the pediatric surgery consultations in the hospital.

Adolescent↗
PubMed2006

Palliative or curative treatment intent affects communication in radiation therapy consultations.

OBJECTIVE: To assess whether communication in radiotherapy consultations is affected by palliative or curative treatment intent. SUBJECTS AND METHODS: The study involved 160 patients and 8 radiation oncologists. Eighty patients visited the radiation oncologist (RO) for palliative treatment and 80 for curative treatment. The consultation prior to radiation treatment was analyzed with the Roter Interaction Analysis System (RIAS). Within three days, patients completed a quality of life questionnaire (EORTC-QLQ-C30). RESULTS: In palliative radiotherapy (PRT) consultations, ROs asked more (closed-ended) biomedical and psychosocial questions and provided more information on prognosis than in consultations for curative radiotherapy (CRT). Patients in both groups provided a great deal of psychosocial information but asked few questions. The ROs expressed more concerns in the PRT consultations, while patients did not. PRT patients received fewer supportive remarks than CRT patients. In both groups, explicit decision-making received little attention. Proxies who accompanied the patients took a more active role in PRT than in CRT consultations. CONCLUSION: Communication in radiotherapy is affected by treatment intent with respect to the main contents of the consultation.

Aged↗
PubMed1982

High medical consultation rates of lead workers after industrial dispute over lead effects.

Medical consultation rates were compared between a group of lead workers (346 males) and two groups of non-lead workers (317 and 329 males) in a newspaper company where a serious industrial dispute took place over health effects of lead three years before this study. The comparison was also made within the group of lead workers. Maximal blood lead concentrations (PbBs) ranged from 0.1 mumol/kg to 3.6 mumol/kg (74 microgram/100 g) with an average of 1.3 mumol/kg in the past three years. Ages averaged 35 years in lead workers, and 34 and 30 years in non-lead workers, the ranges being 19-55 years in all. The consultation rate of lead workers was significantly higher than that of both the non-lead workers (P less than 0.001), when the number of workers who consulted physicians or dentists once or more for a year per 100 workers (general consultation rate) was compared. Disease-specific consultation rates were also higher in lead workers for seven categories of diseases and injuries such as hypertensive disease and peptic ulcers. When lead workers were divided into three groups by PbB or erythrocytes delta-aminolevulinic acid dehydratase (ALAD) levels, however, no significantly high rate was found in the higher PhB groups not lower ALAD groups in terms of general and disease-specific consultation rates. It was concluded that the industrial dispute might have been a major cause of the high consultation rate of lead workers.

Adult↗
PubMed1993

Work, knowledge and argument in specialist consultations: incorporating tacit knowledge into system design and development.

To understand how video telephone technology could support consultations between pathologists and surgeons, this study looked at what constitutes 'work' in clinical consultations. Using several methods (participant observation, video and interviews), we found pathologists and surgeons both share and do not share similar understandings of what a consultation is, what one should achieve in a consultation, and what in fact constitutes a 'successful' consultation. Furthermore, the same objects of consultation (the products of 'offstage' work) can be used and defined quite differently depending on how a consultation is framed. Differences and disjunctions like these have to be better understood if computer-supported cooperative healthcare work (CSCHW) applications are to be adopted and accepted.

Communication↗