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PubMedDate not supplied

Pediatricians' perceptions of child psychiatry consultations.

To ascertain pediatrician's expectations of child psychiatric consultants at our facility, a self-report questionnaire was sent to the 135 members of the Department of Pediatrics, The University of Florida Health Science Center, in 1991. The 73 respondents (54%) reported high rates of emotional problems and adverse family situations in their patients, and a majority said they used psychiatric consultation sometimes or often. Adolescents were the patient group most frequently referred, and behavioral problems were the most frequent reasons for consultation requests. Pediatricians most valued a timely response and accessibility from consultants. These results are discussed with reference to the further development of a consultation-liaison service within a child and adolescent psychiatry training program.

Adolescent↗
PubMedDate not supplied

A prospective multicenter study of competency evaluations by psychiatric consultation services.

Psychiatric consultation for assessment of competency is common but infrequently studied. Past studies have used chart reviews. The authors prospectively studied 88 consecutive psychiatric consultations at 3 centers. Competency evaluation was performed to determine whether the patient could 1) sign out of the hospital against medical advice (AMA) (N = 16); 2) give informed consent (N = 16); 3) take care of him-/herself (N = 33); 4) refuse medical care (N = 24); or 5) deal with other matters (N = 12). Patients with a favorable risk-benefit ratio were more likely to be seen in consultation compared with those with an unfavorable ratio. Patients in whom there was concordance in the assessment of the psychiatric consultant and the referring physician (N = 61) were more likely to be male, single, to have psychotropics recommended, to sign out AMA, and to be discharged from the hospital. Patients in whom there was disagreement between the consultee and the consultant merits further study.

Adult↗
PubMed1996

Mental health of hospital consultants: the effects of stress and satisfaction at work.

BACKGROUND: Burnout and psychiatric morbidity among gastroenterologists, surgeons, radiologists, and oncologists in the UK have been estimated by means of a questionnaire-based survey. The relationship between consultants' mental health and their job stress and satisfaction, as well as their job and demographic characteristics, were also examined. METHODS: Psychiatric morbidity was estimated using the 12-item General Health Questionnaire. The three components of burnout-emotional exhaustion, depersonalization, and low personal accomplishment-were assessed using the Maslach Burnout Inventory. Job stress and satisfaction were measured using study-specific questions. FINDINGS: Of 1133 consultants, 882 (78%) returned questionnaires. The estimated prevalence of psychiatric morbidity was 27%, with no significant differences between the four specialist groups. Radiologists reported the highest level of burnout in terms of low personal accomplishment. Job satisfaction significantly protected consultants' mental health against job stress. Three sources of stress were associated with both burnout and psychiatric morbidity; feeling overloaded, and its effect on home life; feeling poorly managed and resourced; and dealing with patients' suffering. Burnout was also associated with low satisfaction in three domains: relationships with patients, relatives and staff; professional status/esteem; intellectual stimulation. In addition, being aged 55 years or less and being single were independent risk factors for burnout. Burnout was also more prevalent among consultants who felt insufficiently trained in communication and management skills. INTERPRETATION: Consultants' mental health is likely to be protected against the high demands of medical practice by maintaining or enhancing job satisfaction, and by providing training in communication and management skills.

Adult↗
PubMed2000

Client evaluation of a consultation team on crimes against children.

OBJECTIVE: Cases of child abuse filed in court as crimes against children represent a small percentage of the total numbers of children maltreated. However, studying crimes of maltreatment against children is important for individual victims and their families, and for theory and policy in order to assure that these cases are managed as well as possible. Forensic consultation teams can perform several functions related to child abuse crimes: provide multidisciplinary expertise in the evaluation of maltreatment cases, offer a method for allocating resources between cases managed by the criminal justice and child protection systems, and provide important research and teaching opportunities. This study reviews the role played by multidisciplinary team consultations based on the perception of client professionals whose agencies pay for an outside consulting forensic team. METHOD: Professionals referring to a forensic team for consultative assistance were asked to evaluate the service during telephone interviews, responding to both structured and unstructured questions. RESULTS: Responding professionals (N= 18) stated that the team increased their confidence that the approach being taken to a case was correct (94%), that missing expertise was provided (100%), that progress was made in cases that might otherwise not have been made (55%), and that ambiguity was reduced (in 83% of referred cases). Using the team sometimes caused delays. Some delays were unacceptable administrative delays while others were considered necessary to assure completeness of the evaluation. CONCLUSION: The use of the team did not result in resolution of all of the cases referred, but referral to the team consistently provided closure for referring professionals. In one-third of the cases studied, if it had not been for the START consultation the cases would not have proceeded to an appropriate criminal or civil resolution.

Child↗
PubMed1995

Higher levels of consultation services increase patient satisfaction.

Satisfaction of patients with pharmacist consultation was studied in 360 pharmacist-patient interactions in 12 pharmacies. Personal interviews conducted when patients exited pharmacies provided 304 (84%) usable responses. Patients who received longer consultations and were provided with more types of information during consultation were more likely to report that their expectations were exceeded. Patients who received more consultation than they expected reported the highest satisfaction with the service, on average. Exceeding patients' expectations for pharmacist consultation appears to be a key component of patient satisfaction with this service.

Data Collection↗
PubMed1997

Geropsychiatric consultation for African-American and Caucasian patients.

We assessed differences in the referral rates of African-American and Caucasian elderly for geropsychiatric consultation. Reasons for referral, assigned diagnoses, and interventions made were also compared. A retrospective chart review of psychiatric consultations was completed for patients aged 65 years and older for a 2-year period. Significantly more consultations were requested Caucasian elderly (6.2%) than for African-American elderly (3.8%). African-American elderly were referred for evaluation of psychosis significantly more often and for assessment of suicide potential significantly less often than Caucasians. Consultants diagnosed African-American elderly with psychotic disorders, specifically schizophrenia, and dementia significantly more often than Caucasians. Caucasian elderly were significantly more often diagnosed with mood disorders, especially depressive disorders. Interventions/recommendations made for Caucasian and African-American elderly did not differ for the most part. Recommendations for legal measures were suggested for African-American elderly more often than for Caucasians. Differences between Caucasian and African-American elderly were observed in consultation referral rates, reasons for referral, and psychiatric diagnoses made. The potential impact of cultural variables and the racial and age differences between hospital staff and patients may account for some of these findings. Further awareness of the needs of African-American elderly is required.

Black or African American↗
PubMed2001

Domains of consultation research in primary care.

The consultation is increasingly viewed as a crucial aspect of general practice medicine, but a variety of methods of conceptualising, describing and modifying its structure and content have been described. This article describes the historical background to the current interest in the consultation, and describes four qualitatively distinct approaches (or 'domains') to understanding the consultation: the psychodynamic; clinical-observational; social-psychological; and sociological. Four key dimensions along which the domains can be differentiated are described. These concern whether the critique of medical practice inherent in the domain is internal or external to the discipline of general practice; whether the focus of the domain is on the consultation participants' identities or activities; whether the key research methodology is quantitative or qualitative in character; and the degree to which the objective of research within the domain is to describe current practice or prescribe ways of conducting the consultation. Methods of encouraging work across domains are discussed.

Family Practice↗
PubMed2002

Women's views of consultations about familial risk of breast cancer in primary care.

Developments within genetic testing may increase demands on general practitioners to advise about family history of breast cancer (FHBC). This descriptive, qualitative study, investigated women's views of GP consultations about FHBC and their context. Participants were women from the general population who had experienced a primary care consultation in which FHBC was mentioned, as reported by the practitioner. Information about women's views of consultation context was obtained from 72 telephone interviews. More in-depth information about context and women's evaluations of FHBC consultations were obtained from a sub-sample of 20 face to face interviews. FHBC was rarely the main focus of consultations. It featured as a part of an overall discussion of breast symptoms, treatment and cancer risk. Women's understanding of heredity and disease was often idiosyncratic and might differ from biomedical models. A main task for clinicians appeared to be appropriate reassurance. Failure to reassure was linked to a failure to provide explanations at the woman's level of understanding. Clinicians cannot assume that patients share their perceptions of the mechanisms of disease and heredity. Instead they need to ascertain the patient's understanding and provide explanations accordingly. GPs need to have, or access, enough knowledge to inform and reassure.

Adult↗
PubMed2005

[Frequency of psychotic-like symptoms among adults consulting general practitioners].

OBJECTIVES: To assess the frequency of the most frequently observed psychotic-like symptoms in adults consulting general practitioners and to describe their principal characteristics and management. METHODS: Observational epidemiologic survey of 1200 randomly selected general practitioners, distributed throughout France. The symptoms considered were those modified from the BPRS (Brief Psychiatric Rating Scale). During the two-week survey, practitioners recorded the total number of children and adults consulting them and the number with psychotic-like symptoms. They described the characteristics and management of the first three adults with these symptoms (chronological selection). RESULTS: The mean rate of adults with psychotic-like symptoms was 4.9 +/- 8.1% (95% confidence interval: 4.4, 5.4%) during the 12 618 consultation days assessed. The mean age of these patients was 52 years, with equal numbers of men and women. At the consultation, 18.6% were disabled or on short-term sick-leave from work because of the psychiatric disorder; 35.3% of the patients had no known history of psychiatric disorders. Nearly all these patients (95.2%) had more than one psychotic-like symptom. The principal such symptoms were: "changes in behavior, presentation, or interpersonal relations" (62.0%), "bizarre behavior" (48.2%), "depression" and "anxiety" (49.7 and 42.2%), "unusual thought content" or "conceptual disorganization" (29.3 and 26.9%). Most patients received outpatient pharmaceutical management. CONCLUSION: We observed a greater frequency of psychotic-like symptoms in adults consulting general practitioners than expected.

Adult↗
PubMed1999

Neurologic consultations in children with systemic cancer.

The frequency and severity of neurologic symptoms in children with systemic cancer is unknown. The authors reviewed the records of children with systemic cancer for whom a neurologic consultation was requested between 1993 and 1996. The 157 patients had 161 malignancies and 205 consultations. Leukemia (59) and lymphoma (34) were the most common malignancies. The 68 solid tumors included neuroblastoma (13), Ewing's sarcoma, and rhabdomyosarcoma (10 each). In contrast to adults, in whom back pain and altered mental status are the most common reasons for neurologic consultation, headache (33) and seizures (29) were the most common symptoms in children. Structural lesions were present in 84% of patients with headache and focal deficit and in 14% of patients with isolated headache. Structural disease was identified in 37% of children with seizures. Neurologic signs were caused by complications of cancer therapy in 70 instances and to direct tumor invasion of the nervous system in 60. In 71 consultations, neurologic symptoms could not be attributed to cancer or its treatment. The spectrum of neurologic symptoms in children with cancer differs from adults and requires the consulting neurologist to have a thorough knowledge of childhood cancer and its effects on the nervous system.

Adolescent↗
PubMed2000

Improving the quality of care through routine teleradiology consultation.

RATIONALE AND OBJECTIVES: The hypotheses of this study were as follows: (a) University subspecialty radiologists can provide consultations effectively to general radiologists as part of routine clinical operations; (b) these consultations will improve the quality of the final radiologic report; and (c) the consultations will improve the care process and may save money, as well. MATERIALS AND METHODS: For 2,012 consecutive computed tomographic or magnetic resonance (MR) imaging studies, the initial interpretations provided by radiology generalists were subsequently reviewed by specialists, with a final consensus report available. "Truth" was established by final consensus reports. To control for potential bias, 150 adult MR imaging and 250 pediatric radiologic studies were interpreted initially by specialists and then by generalists. Again, truth was established by final consensus reports. RESULTS: There was disagreement between generalist and specialist radiologist interpretations in 427 (21.2%) of the cases reviewed. These disagreements were stratified further by independent specialists, who graded them as important, very important, or unimportant. Differences were considered important or very important in 99% of the cases reviewed. CONCLUSION: Consultations by subspecialty radiologists improved the quality of the radiology reports studied and, at least in some cases, improved the process of care by eliminating unnecessary procedures or suggesting more specific follow-up examinations. The consultation services can be provided cost-effectively from the payer's perspective and may save additional costs when unnecessary procedures can be eliminated.

Humans↗
PubMed2005

The role and scope of the Clinical Nurse Consultant in Wentworth Area Health Service: a qualitative study.

New South Wales Health introduced the role of the Clinical Nurse Consultant in 1987. A review of the role was undertaken by an area health service in Western Sydney, NSW, Australia in 1992 and a number of issues were highlighted in the review process, including diverse roles and responsibilities. In 2000, New South Wales Health acknowledged the diversity of roles and developed a grading system based on five domains of practice. This paper reports the second phase of a two-part study that investigated the scope of practice and perceived level of organisational support provided for the Clinical Nurse Consultants in the area health service. Focus group interviews, one for managers and two for nurse consultants, were conducted in order to collect data. Ten Clinical Nurse Consultants, representative of each grade and seven managers, covering various clinical streams, took part in the study. Data were analysed using content analysis and coded using constant comparison and contrast of codes. Results of the study reveal a lack of clarity and understanding of the new grading system. There is an indication that the role is very individual and the incumbents are often overloaded by work and the maze of demands put on them by numerous competing forces. Many of the Clinical Nurse Consultants felt they were working at a grade higher than their position classification. There appears to be a significant need to clarify the roles of each of these members of the health care system and to provide a better reporting scheme.

Attitude of Health Personnel↗
PubMed2002

The professional status of bioethics consultation.

Is bioethics consultation a profession? With few exceptions, the arguments and counterarguments about whether healthcare ethics consultation is a profession have ignored the historical and cultural development of professions in the United States, the ways social changes have altered the work and boundaries of all professions, and the professionalization theories that explain how modern societies institutionalize expertise in professions. This interdisciplinary analysis begins to fill this gap by framing the debate within a larger theoretical context heretofore missing from the bioethics literature. Specifically, the question of whether ethics consultation is a profession is examined from the perspectives of trait theory, Wilensky's five-stage process of professionalization, Abbott's interdependent system of professions, and Haug's deprofessionalization thesis. While healthcare ethics consultation does not meet the criteria to claim professional status, neither could most professions pass these ideal theoretical standards. Instead of a yes or no dichotomous response to the question, it is more helpful to envision a professionalization continuum with sales clerks or carpenters at one end and medicine or law at the other. During the past decade healthcare ethics consultation has been moving along this continuum toward greater professional status.

Bioethical Issues↗
PubMed2001

[Consultation in pediatric nursing].

Consultation in nursing is not only a question of technique and method. For nursing personnel to qualify as consultants they are compelled to confront its goals and its significance. Moreover, the part of the nurses within consultation must be clarified and the question of the particularities of consultation in nursing should be dealt with. The following article covers this subject with particular attention to the area of Pediatric Nursing. Long ago, job requirements for nursing staff in this area have involved looking not only after the sick child but after its entire family, too. Consultation in nursing is considered an independent plan designed to support the family in coping both with wellness and sickness and the latter's consequences. The adequate education and training will help nursing staff to perform these duties.

Child↗
PubMed2001

Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial.

OBJECTIVE: To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness. DESIGN: Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments. SETTING: One hospital orthodontic department and three community health centre clinics in Greater Manchester. Subjects 324 patients who were referred for orthodontic treatment. MAIN OUTCOME MEASURES: The outcome of consultation, the cost and duration of the visit and the consumer's perceptions of the visit. RESULTS: There were no differences in outcome of the consultation. While consumer travel costs and the duration of appointments were significantly higher for the main base clinics, these differences were not great. However, consumers preferred to attend an appointment in an outreach clinic. CONCLUSIONS: There do not appear to be marked advantages or disadvantages in providing consultation appointments for orthodontics in outreach clinics

Analysis of Variance↗
PubMedDate not supplied

Prenatal consultation with a neonatologist prior to preterm delivery.

OBJECTIVE: Evaluate the usefulness of prenatal consultation with a neonatologist before preterm birth. STUDY DESIGN: A questionnaire was administered to mothers 1 week before home discharge of their preterm infant in a single regional level III neonatal intensive care unit. RESULTS: Sixty-seven mothers completed the questionnaire; 84% indicated the consult was useful and 71% were comforted by the consult. However, mothers < 30 weeks' gestation were less likely to be comforted after the consult compared to those > or = 30 weeks. Most frequently, mothers indicated that they were provided with too little detail about retinopathy of prematurity and intraventricular hemorrhage. CONCLUSIONS: Most mothers delivering a preterm infant describe the prenatal consultation with a neonatologist as useful. The majority of mothers are comforted by the information presented.

Adolescent↗
PubMed2001

A randomized, controlled trial to study the effect of exercise consultation on the promotion of physical activity in people with Type 2 diabetes: a pilot study.

AIM: To evaluate the effect of exercise consultation on promotion of physical activity in people with Type 2 diabetes. METHODS: Twenty-six sedentary people with Type 2 diabetes were randomly assigned to receive an exercise consultation and standard exercise information (experimental) or standard exercise information alone (control). Exercise consultation is a one-to-one discussion, based on the transtheoretical model, designed to educate, strengthen motivation and develop realistic strategies to promote physical activity. Changes from baseline at five weeks were assessed in (a) stage of exercise behaviour (b) physical activity levels (7-day recall questionnaire and an accelerometer) (c) quality of life (SF-36 Health Survey and 22-Item Well-Being Questionnaire). RESULTS: 82% (9/11) of participants receiving a consultation increased their stage of exercise behaviour compared to 33% (4/12) of controls (chi2 = 5.4, P = 0.02). Physical activity counts/week increased by 4% (1636 067/1696 191) in the experimental group and decreased by 9% (1560 960/1725 510) in controls. A significant difference was recorded for the change in activity counts per week from baseline to follow-up between the experimental and control group (98% CI = 60 673-710 827). The number of participants taking part in sport or leisure activity increased by 55% (6/11) in the experimental group and decreased by 6% (1/12) in controls. Positive changes were evident in the experimental group, compared to controls, in both quality of life questionnaires. CONCLUSION: Exercise consultation is more effective in stimulating exercise behaviour change in the short term than a standard exercise leaflet.

Diabetes Mellitus, Type 2↗
PubMed2000

The prevalence of gastro-oesophageal reflux symptoms in a UK population and the consultation behaviour of patients with these symptoms.

BACKGROUND: Patients consulting with gastro-oesophageal reflux symptoms (GORS) may differ from nonconsulters. AIM: To describe these differences in a UK population. METHODS: A postal questionnaire was sent to 4432 adults. Definitions used were GORS (either heartburn or acid regurgitation on more than six occasions during the previous year), dyspepsia (upper abdominal pain or discomfort on more than six occasions during the previous year) and irritable bowel syndrome (abdominal pain with three or more Manning criteria). Socio-economic status was identified by the Standard Occupational Classification. RESULTS: With a 71.7% response, GORS were reported by 28.7% of the sample, it was unaffected by gender and age but was more common among the socially disadvantaged (P < 0. 005). Less than 25% of GORS patients consulted during the previous year. Increasing age (chi2 for trend; P < 0.001) and coexisting upper abdominal symptoms (chi2 P < 0.001) positively influenced consultation behaviour, but it was unaffected by socio-economic status, gender, or the coexistence of irritable bowel syndrome. Dyspepsia and nausea independently predicted consultation. CONCLUSIONS: GORS are especially common among the deprived. Socio-economic variables do not affect consultation behaviour, but the patient's age and the burden (number and type) of associated symptoms do.

Adult↗