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 1,351 records · Page 75Linked to original sources
PubMed2003

The National HIV Telephone Consultation Service (Warmline): a clinical resource for physicians caring for African-Americans.

The National HIV Telephone Consultion Service (Warmline) at San Francisco General Hospital is a free clinical consultation service that provides expert medical and clinical pharmacy guidance to clinicians caring for patients with HIV/AIDS. Consultation can be especially useful when making critically important decisions about antiretroviral therapy and opportunistic infections. The Warmline has served an essential role for the many clinicians who are not AIDS experts but play key roles In HIV care, but do not have ready access to expert consultation. In addition, the Warmline serves a a medical and clinical pharmacy resource to other AID experts. Because the AIDS epidemic in the US profoundly affects African-Americans, the Warmline can be a valuable resource for African-American physicans and clinicians caring for African-American patients.

Black or African American↗
PubMedDate not supplied

Comparison of store and forward method of teledermatology with face-to-face consultation.

BACKGROUND: To compare the accuracy of store and forward method of teledermatology with the traditional face-to-face consultation. METHODS: The comparison was done between Institute of Dermatology King Edward Medical College Lahore that served as teledermatology center and Dermatology Department of Pakistan Institute of Medical Sciences Islamabad from where patients were selected. Telmedpak provided the technical support. Thirty three patients were selected from outpatient department of PIMS and images were taken using a digital camera. Images were stored in computer and were sent to Institute of Dermatology via e-mail for Teleconsultation along with a short history and examination findings. Diagnosis of consultant after face-to-face consultation was then compared with the image based diagnosis that is after teleconsultation. RESULTS: In 81% of the cases the diagnosis on face-to-face consultation was same (p < 0.05) while in 18% of the cases the two diagnoses differed. In 9% (n = 3) of the cases, image resolution was not good but out of these three, diagnosis was same in two and differed in one case. CONCLUSION: This study concludes that store and forward method of teledermatology is reliable and can provide a means of increasing access to dermatological care in rural and under-served areas.

Cohort Studies↗
PubMed1988

The consultant's image.

Nurses provide consultation in various forms and in many different settings. Paramount to the success of these encounters is the initial relationship established between client and consultant. Although the consultation literature discusses the importance of this initial relationship in terms of successful outcome, very little attention has been given to how this relationship may be established. The author explores the impact of dress on establishing this initial relationship in the consultation process.

Clothing↗
PubMed1998

Consultation between cardiologists and generalists in the management of acute myocardial infarction: implications for quality of care.

BACKGROUND: The rapid expansion of managed care in the United States has increased debate regarding the appropriate mix of generalist and specialist involvement in medical care. OBJECTIVE: To compare the quality of medical care when generalists and cardiologists work separately or together in the management of patients with acute myocardial infarction (AMI). METHODS: We reviewed the charts of 1716 patients with AMI treated at 22 Minnesota hospitals between 1992 and 1993. Patients eligible for thrombolytic aspirin, beta-blockers, and lidocaine therapy were identified using criteria from the 1991 American College of Cardiology guidelines for the management of AMI. We compared the use of these drugs among eligible patients whose attending physician was a generalist with no cardiologist input, a generalist with a cardiologist consultation, and a cardiologist alone. RESULTS: Patients cared for by a cardiologist alone were younger, presented earlier to the hospital, were more likely to be male, had less severe comorbidity, and were more likely to have an ST elevation of 1 mm or more than generalists' patients. Controlling for these differences, there was no variation in the use of effective agents between patients cared for by a cardiologist attending physician and a generalist with a consultation by a cardiologist. However, there was a consistent trend toward increased use of aspirin, thrombolytics, and beta-blockers in these patients compared with those with a generalist attending physician only (P<.05 for beta-blockers only). Differences between groups in the use of lidocaine were not statistically significant. The adjusted probabilities of use of thrombolytics for consultative care and cardiologist attending physicians were 0.73 for both. Corresponding probabilities were 0.86 and 0.85 for aspirin and 0.59 and 0.57 for beta-blockers, respectively. CONCLUSIONS: For patients with AMI, consultation between generalists and specialists may improve the quality of care. Recent policy debates that have focused solely on access to specialists have ignored the important issue of coordination of care between generalist and specialist physicians. In hospitals where cardiology services are available, generalists may be caring for patients with AMI who are older and more frail. Future research and policy analyses should examine whether this pattern of selective referral is true for other medical conditions.

Adrenergic beta-Antagonists↗
PubMed1981

An interdisciplinary comparison of consultation outcomes. Psychiatry vs cardiology.

Responses to cardiologists' and psychiatrists' recommendations for drugs and diagnostic actions were compared in a retrospective study of 788 consultations. Variables significantly related to outcome achieved by cardiologists and psychiatrists were identified; similarities among these variables were evident only for the drug recommendations. Cardiologists' recommendations achieved a higher rate of concordance than psychiatrists' for both drugs and diagnostic actions. For drug recommendations, the interservice discrepancy in concordance was directly related to differences in timing of the consultations and incidence of recommendations to start a drug. For diagnostic recommendations, however, the difference was directly related to the consultants' service. The following factors may explain the less favorable outcome for psychiatrists' diagnostic recommendations: (1) the reasons for seeking psychiatric consultation, (2) the consultees' expectations, and (3) the skill of the psychiatrists in offering these recommendations.

Cardiology↗
PubMed1995

Analysis of American College of Surgeons trauma consultation program.

OBJECTIVE: To identify the criteria deficiencies found during peer consultation of hospitals and the relationship to subsequent verification. METHODS: Between September 1987 and December 1992, 52 hospitals had consultation visits using American College of Surgeons criteria. Each report was studied for deficiencies, frequency of deficiencies, and relationship to verification. RESULTS: There are 108 American College of Surgeons criteria. Thirty-five different criteria deficiencies were found. The number of deficiencies per hospital ranged from zero to 12. The more frequent deficiencies included a lack of the following: quality improvement, 35 (67%); trauma service, 20 (38%); trauma surgeon in emergency department, 20 (38%); 24-hour operating room availability, 17 (33%); trauma registry, 17 (33%); trauma continuing medical education, 16 (31%); trauma director, 15 (29%); computed tomography technician in hospital, 15 (29%); research, 14 (27%); trauma coordinator, 14 (27%); and neurosurgeon availability, 13 (25%). No hospital that lacked commitment of surgeons (n = 12) or hospital (n = 3) requested a verification visit. Twenty-four hospitals (46%) achieved verification by February 1994. Twenty-eight hospitals had six or fewer deficiencies, with 19 (68%) verified. Twenty-four hospitals had seven or more deficiencies, with only five (21%) subsequently verified. Verification visits followed consultation by 3 to 52 months. Two hospitals with nine deficiencies were verified after 30 and 48 months, although one failed its first verification visit. CONCLUSIONS: American College of Surgeons consultation assists hospitals to identify their trauma center capability and appears to improve their ability to pass subsequent trauma center verification. Most criteria deficiencies are correctable. Lack of commitment by the surgeons or hospital is difficult to correct. There is an inverse relationship between the number of deficiencies and subsequent verification.

General Surgery↗
PubMed1999

Enhancement of clinicians' diagnostic reasoning by computer-based consultation: a multisite study of 2 systems.

CONTEXT: Computer-based diagnostic decision support systems (DSSs) were developed to improve health care quality by providing accurate, useful, and timely diagnostic information to clinicians. However, most studies have emphasized the accuracy of the computer system alone, without placing clinicians in the role of direct users. OBJECTIVE: To explore the extent to which consultations with DSSs improve clinicians' diagnostic hypotheses in a set of diagnostically challenging cases. DESIGN: Partially randomized controlled trial conducted in a laboratory setting, using a prospective balanced experimental design in 1995-1998. SETTING: Three academic medical centers, none of which were involved in the development of the DSSs. PARTICIPANTS: A total of 216 physicians: 72 at each site, including 24 internal medicine faculty members, 24 senior residents, and 24 fourth-year medical students. One physician's data were lost to analysis. INTERVENTION: Two DSSs, ILIAD (version 4.2) and Quick Medical Reference (QMR; version 3.7.1), were used by participants for diagnostic evaluation of a total of 36 cases based on actual patients. After training, each subject evaluated 9 of the 36 cases, first without and then using a DSS, and suggested an ordered list of diagnostic hypotheses after each evaluation. MAIN OUTCOME MEASURE: Diagnostic accuracy, measured as the presence of the correct diagnosis on the hypothesis list and also using a derived diagnostic quality score, before and after consultation with the DSSs. RESULTS: Correct diagnoses appeared in subjects' hypothesis lists for 39.5% of cases prior to consultation and 45.4% of cases after consultation. Subjects' mean diagnostic quality scores increased from 5.7 (95% confidence interval [CI], 5.5-5.9) to 6.1 (95% CI, 5.9-6.3) (effect size: Cohen d = 0.32; 95% CI, 0.23-0.41; P<.001). Larger increases (P = .048) were observed for students than for residents and faculty. Effect size varied significantly (P<.02) by DSS (Cohen d = 0.20; 95% CI, 0.08-0.32 for ILIAD vs Cohen d = 0.45; 95% CI, 0.31-0.59 for QMR). CONCLUSIONS: Our study supports the idea that "hands-on" use of diagnostic DSSs can influence diagnostic reasoning of clinicians. The larger effect for students suggests a possible educational role for these systems.

Decision Support Techniques↗
PubMed2000

International Consultation on Urological Diseases: a decade of progress.

The International Consultation on Urological Diseases (ICUD), under the cosponsorship of the World Health Organization (WHO), the International Society of Urology (SIU), and the International Union Against Cancer (UICC), is active in the organization of global consultations on urological diseases. The major urological associations from the five continents (the American Urological Association (AUA), the Urological Association of Asia (UAA), the Confederation Americana Urologia (CAU), and the European Association of Urology (EAU)), together with societies with expertise in specific programs such as the International Continence Society, the International Society for Impotence Research, the International Prostate Health Council, the American Cancer Society, the International Union Against Cancer, and the European Organization for Research and Treatment of Cancer, came together in the late 1980s on the basis of their proven record in organizing successful international meetings on urological cancer to initiate the concept of the ICUD. At the suggestion of the WHO, a First International Consultation on Benign Prostatic Hypertrophy (BPH) was organized in 1991, not only to provide recommendations to medical practitioners but also to define and plan future research on the subject. The formula, based on global multiprofessional collaboration and expertise, exceeded expectations, and other consultations were to follow, e.g., on prostate cancer, incontinence, erectile dysfunctions, and nosocomial infections. In 1994 it became necessary to establish a legal nongovernmental organization to foster the goals of the ICUD, essentially for the creation of awareness, knowledge, and recommendations on the diagnosis and treatment of urological diseases.

Humans↗
PubMed2003

Workplace health and safety regulations: Impact of enforcement and consultation on workers' compensation claims rates in Washington State.

BACKGROUND: There has been considerable debate in the public policy arena about the appropriate mix of regulatory enforcement and consultation in achieving desired health and safety behavior across industries. Recently there has been a shift in federal policy toward voluntary approaches and constraining the scope of enforcement programs, although there is little evidence that this might improve health and safety outcomes. To address this, we examined changes in lost time workers compensation claims rates for Washington State employers who had (1) no OSHA State Plan (WISHA) activity, (2) enforcement, (3) consultation, and (4) both types of visits. METHODS: Compensable claims rates, hours, and WISHA activity were determined for each employer account with a single business location that had payroll hours reported for every quarter from 1997-2000 and more than 10 employees. We used a generalized estimating equations (GEE) approach to Poisson regression to model the association between WISHA activity and claims rate controlling for other external factors. RESULTS: Controlling for previous claims rate and average size, claims rates for employers with WISHA enforcement activity declined 22.5% in fixed site industry SIC codes compared to 7% among employers with no WISHA activity (P < 0.05), and in non-fixed site SICs (e.g., construction) claims rates declined 12.8% for employers with enforcement activity compared to a 7.4% decline for those with no WISHA activity (P > 0.10). WISHA consultation activity was not associated with a greater decline in compensable claims rates (-2.3% for fixed sites and +3.5% for non-fixed sites). WISHA activity did not adversely affect worksite survivability through the study period. CONCLUSIONS: Enforcement inspections are significantly associated with decreasing compensable workers compensation claims rates especially for fixed site employers. We were unable to identify an association between consultation activities and decreasing claims rates.

Government Regulation↗
PubMed2005

A qualitative study of interphysician telephone consultations: extending the opinion leader theory.

INTRODUCTION: It has been suggested that the use of opinion leaders in the dissemination of information may be an effective method of changing clinical practice. Recent reviews on this topic, however, have found mixed results and have concluded that further research is needed to explore the circumstances that effectively utilize opinion leaders. We studied the interphysician telephone consultation, a situation in medical practice in which we see opinion leaders at work, to generate a grounded theory of opinion leader activity. METHODS: Data were collected and triangulated among 3 sources: documentation of 129 telephone consultations received, 51 hours of field observations of consultants, and in-depth interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methods. RESULTS: A rich description of the context and mechanisms of opinion leader activity emerged. The results describe that opinion leader activity is effective in an informal context in which the practicing physician initiates the exchange. Valuable elements of opinion leader activity that emerged included the provision of a personal touch, reassurance, and advice that blends clinical experience with published evidence. DISCUSSION: Our results suggest that key to effective opinion leader activity is an informal practitioner-initiated context. Formal didactic sessions led by opinion leaders, therefore, may not be an effective format. In addition to evidence-based medicine, practicing physicians value "experience-based medicine" and the personal touch and reassurance that contact with an opinion leader can provide. Using opinion leaders as a means of balancing these 2 paradigms may be a useful model for continuing medical education in this domain.

Canada↗
PubMed1988

The Clinical Pharmacology Consultation Service: results of a physician survey before and after implementation.

A total of 175 physicians were surveyed by questionnaire before a Clinical Pharmacology Consult Service was started. Of those that responded, 72% thought the service would be helpful, although 40% said they would use the service no more than once a month. Most physicians (75%) preferred self-initiated consultations to automatic surveillance. Ninety-two percent believed a physician should be involved in making drug recommendations. A second questionnaire was circulated 30 months later. Actual use of the service closely paralleled the results of the first survey. There was an increased preference for automatic surveillance (5% vs 32%) and many physicians (48%) indicated they felt comfortable accepting drug consultations from a pharmacist or clinical pharmacist. Despite a general attitude of acceptance, the majority of respondents ranked the Clinical Pharmacology Consult Service last as a source of drug information.

Pharmacology, Clinical↗
PubMed1993

Guidelines for using psychometric consultants in nursing studies.

Consultation for measurement issues is an increasingly common expectation for many studies, yet there are few published guidelines on the use of psychometric consultants. The role of the psychometrician as research consultant is discussed and questions commonly asked of these measurement experts are identified. Consultation when selecting, revising, and developing data collection instruments is explored.

Consultants↗
PubMedDate not supplied

Communication in the cancer 'bad news' consultation: patient perceptions and psychological adjustment.

The purpose of this study was to explore relationships between breast cancer survivors' experiences during the diagnostic consultation and their subsequent long-term psychological adjustment. Sixty women (M age=53 years) who had been diagnosed with local or regional breast cancer (Stage 0-IIIA) an average of 28 months prior were interviewed by telephone. Measures included: Cancer Diagnostic Interview Scale, Anxiety subscale of the Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist - Civilian Version, Center for Epidemiologic Studies Depression Scale, and ad hoc items regarding memory for, and satisfaction with, the diagnostic consultation. After controlling for demographic and clinical variables, the three CDIS subscales accounted for 12% of the variance in women's PCL-C scores (F change=3.46, p<0.05). The CDIS-Caring subscale was a significant predictor in the 'best-fit' regression model for each of the three indices of long-term distress (all B's>-0.23, p<0.05). In contrast, the CDIS-Competence subscale was not a significant predictor in any of the 'best-fit' models. Additionally, women's satisfaction with physician behavior during the diagnostic consultation was unrelated to all adjustment measures (r's<0.10, p's>0.50). Findings suggest that women's perceptions of physicians' interpersonal skills during the diagnostic consultation are associated with later psychological adjustment.

Adaptation, Psychological↗
PubMed2003

Lay understanding of terms used in cancer consultations.

The study assessed lay understanding of terms used by doctors during cancer consultations. Terms and phrases were selected from 50-videotaped consultations and included in a survey of 105 randomly selected people in a seaside resort. The questionnaire included scenarios containing potentially ambiguous diagnostic/prognostic terms, multiple-choice, comprehension questions and figures on which to locate body organs that could be affected by cancer. Respondents also rated how confident they were about their answers. About half the sample understood euphemisms for the metastatic spread of cancer e.g. 'seedlings' and 'spots in the liver' (44 and 55% respectively). Sixty-three per cent were aware that the term 'metastasis' meant that the cancer was spreading but only 52% understood that the phrase 'the tumour is progressing' was not good news. Yet respondents were fairly confident that they understood these terms. Knowledge of organ location varied. For example, 94% correctly identified the lungs but only 46% located the liver. The findings suggest that a substantial proportion of the lay public do not understand phrases often used in cancer consultations and that knowledge of basic anatomy cannot be assumed. Yet high confidence ratings indicate that asking if patients understand is likely to overestimate comprehension. Awareness of the unfamiliarity of the lay population with cancer-related terms could prompt further explanation in cancer-related consultations.

Adult↗
PubMed1999

"Curbside" consultations in gynecologic oncology: a closer look at a common practice.

OBJECTIVE: The aim of this article is to evaluate the nature and frequency of informal "curbside" consultations in a gynecologic oncology practice. METHODS: A log of all curbside consultations requested from a gynecologic oncologist in a tertiary multispecialty group practice was kept for 2 years (July 1996 to June 1998). New referrals or calls concerning mutual patients were excluded. RESULTS: Three hundred thirty-three requests for advice were received from 87 different physicians. Most (81%) of the calls were from 51 obstetrician/gynecologists (Ob/Gyns); 13% of the calls were from family practitioners or general internists. The four most common topics discussed were lower genital tract dysplasia (18%), endometrial hyperplasia (17%), adnexal masses (11%), and endometrial cancer (10%). Overall, 29% of questions pertained to the management of an invasive gynecologic malignancy. Twenty-four percent of the questions were answered in less than 5 min, 43% in 5-10 min, 29% in 11-20 min, and 4% in over 20 min. The issues discussed were considered simple in 26%, of moderate complexity in 49%, very complex in 22%, and ultracomplex in 3%. One hundred nine questions (33%) were of sufficient complexity to warrant referral to a specialist, which occurred in 52 cases (48%); physicians employed by a staff-model health maintenance organization were less likely to request a formal consultation (14%, chi(2) = 0.001). CONCLUSIONS: Curbside consultations are a frequent occurrence in the practice of a gynecologic oncologist, with most questions posed by general Ob/Gyns. Approximately one-third of the questions were of minimal complexity and involved topics covered in standard textbooks or residency training programs. In contrast, approximately one-third were of sufficient complexity that a casual discussion between colleagues may not yield optimal medical care.

Gynecology↗
PubMed1975

Consultee-centered consultation with a teacher as a technique in behavior management.

Client-centered consultation was effective in helping a teacher to decrease one child's disruptive classroom behavior, and consultee-centered consultation helped the teacher improve her control of the class as a whole. Initially, a client-centered reinforcement program effectively decreased the disruptive behavior of one target child. Later, attention to the teacher's feelings about being the authority figure in the classroom was used in an attempt to modify the behavior of the entire class. The data describing the behavior of a second child in the classroom suggested that this consultee-centered consultation was followed by less classroom disruption. In addition, anecdotal observations indicated that consultee-centered consultation was effective in modifying the behavior of both the teacher and the rest of the class.

Adult↗
PubMed1978

Behavioral versus process consultation interventions in school settings.

Teachers experiencing difficulties in managing disruptive, acting-out children in two parochial first-grade classes were provided either behavioral or process consultation. The behavioral intervention included discussions of behavior modification principles, feedback concerning contingent praise, and individualized behavioral interventions. In contrast, the process consultant used clarifying, supportive, and reflective responses to help the teacher better understand classroom difficulties and enhance her ability to work with problem children. Results of the interventions indicated that during consultation sessions and follow-up, problem behaviors were significantly reduced and attention to desirable behaviors significantly increased. The results were observed in three problem children in the classroom provided with behavioral consultation, and there only. Both teachers rated problem children as being less disruptive following program involvement. Significant positive relations were found between directly observed and teacher ratings of problem behaviors.

Acting Out↗
PubMed1975

The effects of consultation. A review of empirical studies.

Although consultation, as an activity for intervention, has achieved considerable popularity among human service professionals and figures prominently in current federal mental health legislation, a basic question still unanswerable is, "Does it work?" This paper reviews 35 consultation outcome studies reported between 1958 and 1972 in an attempt to provide some answers to this question. Although their quality varies greatly, the evidence seems to lend some support to the effectiveness of consultation as a change method. In 69% of the studies reviewed, positive change was demonstrated on the consultee, client, or system level or at some combination of these. The review also suggests that, despite a need for studies which build cumulatively on earlier ones so as to provide comparable data instead of a conglomerate of isolated findings, progress has been made in the evaluation of consultation.

Achievement↗