Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CONSULTATIONS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed2002

[General practice consultation in a hospital emergency department. History, evaluation and prospects].

INSTALLATION OF A GENERAL MEDICINE CONSULTATION: In 1995, in reaction to an increase of more than 35% over three years, related essentially to out-patient consultations, the installation of a general medicine consultation (GMC) near the emergency unit reception area (EUR) was envisaged. The project, developed over 5 years and based on an epidemiological study, was finally set-up in January 2000. The aims of the GMC are to supply information to the patients, help them in their administrative rights, and their subsequent follow-up by an external physician; the benefits expected by the EUR is the re-concentration on heavier and more urgent pathologies. THE FUNCTION OF THE GMC: Exclusively reserved for CCMU 1 patients (level 1 of the clinical classification of emergency unit patients), the GMC relies on general practice, with the presence of general practitioners installed in the SAU (emergency unit) sector, a double admission method (either via the emergency unit, or directly), a means of payment for the consultation and the absence of priority access to the technical network of the hospital. A social services worker is present. RECRUITMENT: After 18 months of activity, the GMC had managed more than 4500 patients and the method of referral via the SAU, almost exclusive at the beginning, has been reduced to a minority. The patients are generally young; socially close to the underprivileged population surrounding the SAU, but not in a situation of precariousness. The four principle motives for consultation are benign traumas, ENT infections, dermatological affections and pain. A DYNAMIC STRUCTURE: The rapid progress in the context of general medicine, and the observations of the physicians and non-physicians participating in this experience, has progressively modified the aim and mission of this GMC, which is gradually becoming a real structure of permanent care. Its originality is its close link between the town and the hospital, whilst permitting the various actors to remain free and independent. The traditional system of permanent care is no longer adapted to our society, and we must rapidly find solutions. The vocation of the GMC is not to become a universal model, but this new experience opens new horizons for the future.

Adult↗
PubMed2003

Effects of ambulatory-care pharmacist consultation on mortality and hospitalization.

OBJECTIVE: To determine the effect of 3 alternative models of ambulatory-care pharmacist consultation on patient survival and hospitalization. STUDY DESIGN: Patients were randomly chosen adult Kaiser Permanente (KP) Southern California enrollees with at least 1 prescription in the base year. The demonstration lasted 23 months. Using time-dependent proportional hazards estimation, survival and hospitalization were examined across 5 patient risk groups. INTERVENTIONS: The pharmacy interventions were (1) consultation about new or changed prescriptions as mandated by 1992 state and federal regulations (State model), (2) consultation focused on selected high-risk ambulatory care patients (KP model), and (3) pre-1992 standard care (Control model). RESULTS: In the 6 service areas in which only 1 of the models was implemented, both the KP (relative risk [RR] = 0.295, P < .001) and State (RR = 0.338, P < .001) models significantly reduced emergency hospital admissions over 2 years compared with the Control model when measured across all risk groups. The State model also was associated with fewer urgent and emergency admissions (RR = 0.854, P < .001). In the randomized treatment sample of 5499 patients, the KP model was associated with lower total mortality per new prescription filled (RR = 0.921, P < .01), and significantly lower hospitalization and mortality in high-risk patient groups. CONCLUSIONS: Intensive outpatient pharmacist consultation targeting high-risk patients would improve survival and decrease hospitalization rates. Broader nontargeted consultation would reduce hospitalizations, but was not associated with lower mortality within the 2-year intervention.

Adult↗
PubMedDate not supplied

What general psychiatrists ask addiction psychiatrists: a review of 381 substance abuse consultations in a psychiatric hospital.

We reviewed the records of 381 consecutive substance abuse consultations completed by the Substance Abuse Consultation Service (SACS) of McLean Hospital to ascertain 1) the most frequent reasons why general psychiatrists consulted the SACS, and 2) the clinical characteristics of these patients. The most frequent reasons for consultation were to make aftercare recommendations (66.1%) or to make (19.7%) or clarify (6.3%) a substance use disorder (SUD) diagnosis. Mood disorders were the most prevalent co-occurring psychiatric disorder; alcohol use disorders were the most prevalent SUDs. The findings indicate the potential utility of a substance abuse consultation service in a psychiatric hospital.

Adult↗
PubMed2001

The effect of introducing a dedicated emergency theatre and altering consultant on-call commitments in a large children's hospital.

BACKGROUND: Two recommendations of NCEPOD were the introduction of dedicated emergency theatres and a higher level of consultant involvement in emergency cases. In May 1998 a dedicated emergency theatre was introduced in the Royal Hospital for Sick Children, Glasgow. At the same time the on-call rota of the Consultant Paediatric Surgeons was changed from days on-call to a period of one week, during which elective commitments were cancelled. METHOD: A retrospective audit was conducted for the 12-month periods before and after these changes. Start times of emergency cases and grades of surgeons were obtained from the theatre database. RESULTS: The proportion of emergency operations carried out during on call periods (weekends and weekdays after 5 pm) decreased for general paediatric and neonatal surgery (OR = 0.7, p < 0.01). There was an increase in the proportion of daytime emergency cases performed before 1 pm (OR = 0.28, p < 0.01). The Consultant Paediatric Surgeons were involved in more emergency cases (OR = 0.60, p < 0.01). CONCLUSIONS: The provision of a dedicated emergency theatre increased the proportion of emergency cases performed during normal working hours, particularly before 1 pm. Cancelling elective commitments for Consultant Paediatric Surgeons ensured higher levels of consultant input into daytime emergency cases.

Consultants↗
PubMed2003

[Epidemiologic profile of sexually transmitted diseases (STD) through a specialized consultation of STD].

INTRODUCTION: A confidential, free and specialised consultation of sexually transmitted diseases (STD) was initiated since 1993 in the department of Dermatology of hospital Charles Nicolle. We present the epidemiological and clinical features of this consultation. PATIENTS AND METHODS: It is a retrospective study including patients consulting during a period of 7 years (1993-1999). 546 patients were included. The mean age of our patients was 29 years and the sex-ratio 9. The diagnosis of urethritis was done for 242 patients. This diagnosis was clinic in the most cases. Urethral swabs was done for 71 patients. Neisseria gonorrhoeae was isolated in 56 cases and Chlamydia trachomatis in 15 cases. 41 patients were directed to our consultation for a positive syphilis serology. Condyloma were diagnosed in 23 cases and scabies in 12 cases. HIV serology was positive in 10 cases. In 3 cases, the diagnosis of HIV infection was done in this consultation. DISCUSSION: The epidemiologic profile showed a frequency of young men, bachelors and having multiple sexual partners. Clinically, urethritis was the principal STD observed.

Adolescent↗
PubMed1992

[The influence of a prior appointment on primary care consultations in the Murcia region].

AIM: Analysis of how the prior appointment system affects various indicators of attendance. DESIGN: A multi-centered intervention study. SITE. Faculty of Medicine. Department of Social-Health Sciences. PATIENTS AND OTHER PARTICIPANTS: Patients seen in the general consulting-rooms of urban and rural Health Centres during the same months in two successive years, i.e. before and after setting up the prior appointment system. INTERVENTIONS: Introduction of the prior appointment programme (a consultation, with the hour and date arranged beforehand). Questionnaire given to the patient at the end of the consultation. MEASUREMENTS AND MAIN FINDINGS: The personal variations of age and sex, and also of those relating to the medical side were compared by means of the questionnaire, before and after the introduction of the prior appointment system. Significant differences were only seen in relation to hospital referral, which tripled; and to the number of prescriptions per person, which increased. CONCLUSIONS: The prior appointment system has meant less waiting-time for patients and a rationalisation of consultation time; but it has not substantially altered the content of the consultation.

Adolescent↗
PubMedDate not supplied

[Role of systemic consultation in the psychiatric diagnosis].

Basing on the example of one patient and her family, the advantages and disadvantages of a systemic consultation are presented. The patient was hospitalised due to schizophrenia. In the given example the psychiatrist was an observer of the consultation conducted by a therapist from the ward. A systemic consultation allowed a "multiple-picture" to be obtained: the family members and the patient presented their own understanding of the situation, their "stories" This new and multi-perspective description, showing the patient's symptoms functionality caused diagnostic uncertainty in the psychiatrist--how far is the diagnosis of schizophrenia a justifiable one. The possibility to empthasize with the existential, psychological and family problems of the patient caused a scepticism in the psychiatrist, towards the stigmatizing diagnosis. The authors stress the danger arising in the systemic consultation, which broadens and deepens the knowledge on the patient's situation. According to the authors, the systemic consultation is necessary to understand the social context of the patient and to formulate a complex treatment plan. At the same time however, the multiple layered perspective (which contains the psychological, social and existential domains of the patient) should not over-shadow the psychopathological domain. For the therapeutic team, the consideration of the given levels of systemic reality description remains a challenge.

Adult↗
PubMed2002

[Health care reform in progress. Noticeable improvement in availability of consultation in primary health care].

UNLABELLED: The aim of this study was to check whether after 3-year functioning of reformed health care the improvement of services in primary health care availability could be asserted. Method of the study was a comparison of standardized index of consultations realized in the primary health care. The study was realized in 1998 (before the reform) and in years 1999-2001 (after changes). Materials were also results of study of social opinion in 1997 and results of questionnaire study of patient satisfaction in 2000 and 2001. The period of the study of attendance was 3 years (from 1st March 1999 to 28th February 2002). As a result of analyses explicit increase in adequate standardized consultations index in the primary health care was ascertained. The increase in this index was (in the primary health care) from 2.96 before the reform to 6.1 in family practice (FP) and 3.62 in regional clinic (the first year of the study). High level of index consultations in FP showed a downward tendency and in the third year of the study was 5.55. Results obtained in questionnaire study of patients' satisfaction in FP showed significant improvement in opinion about consultations availability. The increase of 69.09 points in effective graduation was noticed. CONCLUSIONS: Significant improvement of consultations availability in the primary health care was noticed. The improvement of services availability in the primary health care is especially explicit in location, where general practice is a part of non-public sector and where before 1999 opinions about bad availability were significant.

Adolescent↗
PubMed1992

[The motives for consultation and the clinical stages of HIV-positive patients attending a health center].

OBJECTIVE: To find the clinical condition and motives for consultation of HIV + patients seen in our Health Centre. DESIGN: This was an observational and retrospective study. SITE. The study was carried out in the Primary Care context, in the Natahoyo Health Centre (Gijón). PATIENTS AND OTHERS PARTICIPANTS: The clinical histories of 26 HIV + patients registered at the Health Centre were studied. These supposed a total of 387 consultations from the day they were diagnosed as seropositive to the 31 August, 1991, or until their death. MAIN MEASUREMENTS AND RESULTS: The 387 consultations recorded broke down into a average of 14.8 consultations per patient (SD 12.7). 43% due to a request for detoxification. Only 5.5% of patients were referred to the second level. In line with the classifications of the W.H.O., 14 patients (56%) would be in stage I; 3 (12%) in stage II; 3 (12%) in stage III; and 5 (20%) in stage IV. CONCLUSIONS: HIV + patients often attend our Health Centre, but mainly for bureaucratic reasons. Consultations due to illness tend to be for minor pathologies, which are almost always treated successfully in the Centre itself. The WHO's classifications were found to be useful for assessing the stage of each HIV + patient at the Primary Care level.

Age Factors↗
PubMed2005

[Consulting work performed by the hospital laboratory. The usefulness of the Laboratory Information Office in Keio University Hospital].

To establish a consultation office for handling questions from physicians and other hospital staff is one way to provide laboratory information for effective utilization of laboratory data. Here I introduce the basis of our Laboratory Information Office in Keio University Hospital. A full-time specialized, technologist is stationed in the office. She answers inquiries using a computer database, informs physicians of abnormal laboratory findings and maintains information exhibited on the web site of the clinical laboratory in the intranet of our hospital. The number of consultations is about 280 per month. The most common area of inquiry that of immuno-serology. Cooperation between the technologist and the clinical pathologists makes it possible to respond more efficiently to the inquiries, and in the future could lead to more useful consultations with clinical physicians. In the future, mutual communication between laboratory consultation offices could be arranged to share knowledge. Also, direct consultation with patients concerning laboratory examinations should be considered, though this may be difficult to implement.

Clinical Laboratory Information Systems↗
PubMed2004

[Internal medicine consultation].

The Internal Medicine consultation plays an important part in the activity of the Medicine Department. This activity is seldom quantified and is usually underestimated. In order to assess the work load represented by this service, the authors designed a prospective study to quantify and analyse the characteristics of the 556 consecutive consultations performed during 12 months. Over half the requests for observation were received after 4 p.m. and 18% were requested urgently; 96,8% were answered on the same day. Of the consultations, 33% came from the Orthopaedics and Trauma Department, 18% from the General Surgery Department and 17% from the Surgical Intermediate Care Unit. Cardio-vascular, infectious and neurological pathology accounted for most of the calls. During the regular working hours, there was'nt a direct contact with the patient's physician in 54% of the consultations. This activity represents an important additional work load to the Internist, with increasing relevance in the improvement of medical care. Our results highlight the need to establish a general medicine consultation service in every Internal Medicine Department and to include this activity in future educational programs.

Adolescent↗
PubMed1992

[Consultation between family physicians and specialists about the hospital admission of patients].

Consultation between GPs and specialists about patients' in-hospital treatment is to be expected from the claim of Dutch GPs that they are responsible for continuous care for the patients on their lists. Data were gathered in the Dutch National Survey of General Practice: registration concerning all patients hospitalized during a three-month period (n = 7815) by 161 GPs. GPs consult specialists most frequently about the decision to admit patients (15% of all admissions). Consultation during patient's stay in hospital (5%) and about the discharge decision and possible aftercare (4%) is less usual. Consultation results from practical circumstances, such as the GP's initiative in the admission and a contact between patient and GP about the admission. The results leave GPs to answer the question whether the little actual consultation about the patient's stay in hospital, discharge and aftercare accords with their task to provide continuous care.

Analysis of Variance↗
PubMed1992

The design and use of the bioethics consultation form.

The emergence of the ethics consultation as a means to resolve moral crises in clinical medicine has revealed the need for a worksheet that would facilitate intake and analysis. The author developed the "Bioethics Consultation Form" as an attempt to remedy this need. The form is arranged in an outline format and is a useful asset to ethics committee discussions and record keeping. The first section covers basic intake data concerning the patient's medical and personal information, advance directives, and values, as well as the values of the physician and family. After the intake section is completed with the above data, the ethics consultant then turns to the analysis section. This second section allows for (1) the discussion of conflicting values, (2) the identification of priorities, and (3) the elucidation of ethical norms relevant to the case. The Bioethics Consultation Form was adopted by the Patient Care Advisory committee of the Franklin Square Hospital Center in Baltimore, Maryland in 1986. The methodology in the use of the form will be discussed. Further, the potential spectrum of consultative cases that can be analyzed using the form will be highlighted.

Bioethics↗
PubMed2005

[Memory loss: a reason for consultation].

INTRODUCTION: Memory loss is an increasingly frequent reason for consultation in neurology. The aim of this work is to know the current frequency as well as the characteristics and disorders of the patients who come for this reason. METHODS: We studied 200 patients who came to general neurology consultation due to loss of memory. RESULTS: 18.47% of the patients who came for the first time to a general neurology consultation did so due to memory loss, this being subjective loss of memory (SLM) in 39% of the cases and referred loss of memory (RLM) in 61% of the cases. The diagnostic groups to which the patients belonged are, in diminishing order, the following: degenerative primary dementia type Alzheimer's disease, mild cognitive impairment, mixed dementia, pure vascular dementia, depressive pseudodementia, attributable to drugs, secondary to systemic disease, non-Alzheimer's type disease primary degenerative dementia, structural reasons, transitory global amnesia and epilepsy. No disease was found in 13% of them, and the generally came due to SLM. CONCLUSIONS: Frequency of memory loss as a reason for consultation continues to growing. Patients studied due to memory loss, in whom no disease is found, are generally those having SLM. In spite of this, SLM is a good predictor of cognitive deterioration. It is important to systematically study of every patient and consults for loss of memory and to investigate the possible use of drugs or toxics that could alter the memory.

Aged↗
PubMed2006

[Present state of outpatient consultation in Gunma University Hospital].

We started outpatient consultation by clinical laboratory physicians in Gunma University Hospital in June, 2002. Three days a week, five clinical laboratory physicians examine outpatients or answer questions concerning laboratory tests in an outpatient consulting room. The number of outpatients referred has gradually increased since we started this consultation. Among the wide rage of cases examined, there have been many preoperative patients with eye disorders from the Department of Ophthalmology. There are some advantages of our outpatient consultation. For example, we are able to give patients a detailed and unrushed explanation of their laboratory data, and close cooperation with clinical laboratory technicians enables physicians to perform quick and smooth echo-guided fine needle aspiration cytology of thyroid nodules. We hope that our consulting work by clinical laboratory physicians will become widely known to patients and doctors.

Ambulatory Care↗
PubMed2006

The effect of postpartum depression on women's consultations with physicians.

BACKGROUND: Postpartum depression is a well-known phenomenon that occurs in about 10% of births and affects the quality of life of the mother as well as the family. As in other cases of depression, under-diagnosis of PPD may keep patients from getting proper care and increase their physical and emotional distress. OBJECTIVES: To identify patients with PPD and to describe their consultation patterns with primary care physicians for themselves and their babies. METHODS: Using a telephone survey and the Edinburgh Postnatal Depression Scale questionnaire we identified PPD in a sample of women who gave birth in HaEmek Medical Center. We also assessed the extent to which the women consulted with family physicians, gynecologists and/or pediatricians. RESULTS: The survey included 574 women, of whom 9.9% were diagnosed with PPD. There was a higher rate of PPD among Arab compared to Jewish women, among women with a prior history of depression, among women whose pregnancy was unplanned, among those who described the course of pregnancy as "difficult," and among women who described their general health as "not good." Women with PPD consulted more with family physicians and pediatricians. The reasons for the consultations are physical and emotional. There were cases of somatization manifested directly by the mother or indirectly through the baby. CONCLUSIONS: Women with PPD have higher consultation rates than those without. By asking a few simple questions it is possible to identify a significant proportion of women with PPD.

Adult↗
PubMed1990

[Problems of the organization of outpatient cardiac consultation services for patients with cardiovascular diseases in a large city].

The experience gained in the study of outpatient consultative cardiac care in a big city such as Leningrad permits one to single out the following stages in the delivery of these services: a polyclinic-based cardiologist--a cardiologist in the consultative-diagnostic polyclinic and (or) an out-patient department at the Research Institute of Cardiology (follow-up centre)--urban specialized centres of consultative care. The main issues requiring improvement in this system are: the necessity of efficient regulation of indications for consultative care at all stages, determination of functional responsibilities of consulting physicians, their role in the system of dispensarization, the drafting of optimum documentation and criteria of performance.

Adult↗
PubMed1990

[Telephone consultations with the pediatrician on-call].

Prospective registration of telephone consultations with the paediatrician-on-call during a period of four months was undertaken. Telephone records were made for this purpose and 256 consultations were registered. In 39% of these consultations, the contact was with a doctor who desired advice about a definite patient. In 36%, the persons making the contact were parents of children attending the paediatric outpatient clinic. 20% of the contacts were from parents of acutely ill children and were without connection with the paediatric department. In 37% of the consultations therapeutic advice was given. The paediatrician-on-call appears to have a function as an emergency telephonic consultant for the primary and secondary health sectors and as the doctor-on-call. Establishing of telephone records in paediatric departments is recommended.

Child↗