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PubMed1976

The mental health center's role in school consultation: toward a new model.

The 1965 Boston Conference on the Education of Psychologists for Community Mental Health recommended a broad movement into the field of education and the development of the consultation function in an array of settings. The coordinator of that conference--at which the term "community psychology" was coined--presents a model for extending and redefining the traditional mental health--school consultation model. In this model consultation that is reaction to an existent problem by the clinical "expert" is integrated with a comprehensive model of collaboration that moves in the direction of systems change. The concept is presented through a case history of successful school--mental health center collaboration, a documentation of a full consultation service program to a large school system.

Child↗
PubMed1995

[The influence of information and communication in the orthodontic consultation and treatment visit. II. The communication style and compliance].

The establishment of a good rapport between dentist and patient is together with providing information a basic prerequisite for successfully motivating the patient to comply with the guidance the dentist provides. Both the style adopted in verbally communicating with the patient and also nonverbal communication play a decisive role in the establishment and maintenance of such a relationship. In the pilot study presented here, which draws on psychological interaction analysis of video recordings taken of the initial consultation with 27 patients and of 28 routine treatment sessions with different patients, the typical interaction patterns between the orthodontist and the patient are objectively assessed and compared. The most important findings of the study were: (1) The mean duration of the chairside sessions was lowest during routine encounters with cooperative patients. (2) During consultations approximately 2/3 of the time was taken up talking to each other. On the other hand, in treatment sessions with uncooperative patients only 1/4 of the time was devoted to verbal communication. (3) The orthodontist dominated the conversation in all groups and especially in conversing with the uncooperative patients. (4) In the consultation sessions the dentist and the patient related relatively strongly to each other. (5) Providing mere information significantly predominated over any discussion of the professional aspects of the treatment. (6) During the consultations eye contact was maintained over almost all of the sessions.(ABSTRACT TRUNCATED AT 250 WORDS)

Communication↗
PubMedDate not supplied

Compliance with the recommendations of medical consultants.

Compliance with the consultant's recommendations is one measure of the effectiveness of a consultation. A previous study showed that compliance was better when fewer recommendations were made. In the subsequent year, consultants were encouraged to limit their recommendations to five or fewer. Despite a significant decrease in the number of recommendations, compliance rates remained essentially unchanged (72%). Multivariate analysis demonstrated that the clinical severity of the patient's disease and the number of associated problems, as well as the types of recommendations, were significant predictors of compliance. Compliance was best for recommendations involving medications (84%) and worst for recommendations involving diagnostic tests (62%). Compliance was also evaluated in the context of a surgeon's view of the appropriateness of the recommendations. For recommendations felt to be essential to patient care the compliance rate was 75%, but it was only 44% for recommendations judged nonessential (p less than 0.001). The consulting internist should be aware that the surgeon's view of the relevance of the recommendations to patient care needs may have an important effect on compliance.

Analysis of Variance↗
PubMed1998

[Neurologic consultation practice in a general hospital of a rural area].

The long-standing consultant service for neurological patients in a general hospital requires questions to about the dimensions and efficiency of being answered cooperation between a general hospital and a neighbouring neurological clinic with a casualty ward and neuroradiology. From 1987 to 1995, 1471 patients with neurological diagnoses were observed retrospectively. The small number of requested consultancies (4-5%) was conspicious related to the total member of patients treated in the general hospital. About 25% of the recommendations of the consultants were realized. The percentage of pensioners and housewives was distinctly higher (45%). With the help of the diagnosis "concussion of the brain" good cooperation was observed between the general physicians to whom the consultant's recommendations had been passed on and the neurological casualty ward. The results, tendencies and possibilities for improvement of interdisciplinary cooperation are discussed.

Adult↗
PubMed2003

Effect of hospitalist consultation on treatment of osteoporosis in hip fracture patients.

The objective of this study was to determine if hospitalist consultation during admission for hip fracture results in improved treatment for osteoporosis. This was a retrospective chart review, carried out in a university-based academic hospital. Administrative discharge data was used to identify patients discharged between 1 September 1999 and 1 September 2001, discharged with the diagnosis of hip fracture. Eighty-two patient charts were reviewed after exclusion for traumatic and pathologic fractures. Treatment for osteoporosis consisted of medications recommended by the National Osteoporosis Foundation (NOF), including calcium (+/-vitamin D), estrogen, raloxifene, calcitonin, alendronate and risedronate. Osteoporosis treatment improvement was defined as the addition of a medication for osteoporosis that strengthened treatment. Twenty-nine percent of patients in our study received treatment for osteoporosis at the time of discharge from the hospitalization for hip fracture. While 20% received calcium, only 7% received a bisphosphonate. Twelve percent received improvement in osteoporosis treatment from admission to discharge. Those that received hospitalist consultation did not have a significant improvement in osteoporosis treatment (P=0.314), but had significantly more co-morbid illnesses and were significantly older than those receiving no consultation (P<0.05). Identification of osteoporosis as a medical problem was significantly associated with osteoporosis treatment (P<0.05). Potential barriers to hospitalist consultation's effect on osteoporosis treatment included patient age and co-morbidities. Further research is needed to identify and overcome barriers to effective osteoporosis treatment in patients with fractures.

Aged↗
PubMed2004

Ethics education in the consulting engineering environment: where do we start?

As a result of in-house discussions stimulated by previous Gonzaga engineering ethics conferences, Coffman Engineers began the implementation of what is to be a company-wide ethics training program. While preparing a curriculum aimed at consulting engineers, we found very little guidance as to how to proceed with most available literature being oriented towards the academic environment. We consulted a number of resources that address the teaching of engineering ethics in higher education, but questioned their applicability for the Consulting Engineering environment. This lack of guidance led us to informal research into the ethical knowledge and attitudes of both consulting engineers and engineering students. Some of our findings were unexpected, and suggest that a simpler approach to teaching ethics to working professionals might be preferred to that typically promoted in higher education.

Consultants↗
PubMed1986

Factors affecting compliance for general medicine consultations to non-internists.

For a general medicine consultation service to be effective, compliance with recommendations is essential, as is an understanding of the factors that improve compliance. Residents in a general medicine consultation service attempted prospectively to improve their skills as consultants and to enhance compliance by implementing the following steps, reported to influence compliance: identify critical recommendations; make early, direct oral contact with the referring surgeon; limit the number of recommendations; and render definite recommendations. At the end of the study period, recommendations were tabulated and categorized as to whether each was diagnostic or therapeutic and critical or noncritical, and the time of contact with the referring surgeons was noted when applicable. Multivariate analysis of the factors, in relation to the type of recommendation, demonstrated that compliance can be improved, especially if a consultant clearly identifies the critical recommendations and makes contact with the referring physician within 24 hours.

Education, Medical, Graduate↗
PubMed1990

Plastic surgery outpatient audit: principles and practice of "consultant only" clinics.

The effect of instituting "consultant only" clinics on plastic surgery outpatient activity was to produce a 19% reduction in both clinic sessions and new patient bookings, but a 50% reduction in booked follow-up patients; non-attender rates reduced from 20% to 11% (Northern General Hospital, April 1986-March 1989). Mean clinic attendances reduced from 35 to 26 (Northern General Hospital) and from 33 to 27 (Barnsley District Hospital)--26% and 18%, respectively. Analysis of new referrals to such clinics in the 6 months January-June 1989 showed 41% of patients came from general practitioners, although 80% of "aesthetic" conditions came from this source. 31% of referrals were for malignancy, 51/72 (70%) being basal cell carcinomas. Malignancies waited on average 4 weeks, benign conditions 15 weeks, and "aesthetic" conditions 28 weeks from referral to consultation. Such clinic management has dramatically reduced follow-up episodes, but regulation of new patient attendances is associated with appreciable waiting times for non-malignant conditions. To reduce such waiting times and pursue a "consultant only" clinic policy nationally requires many more consultants.

Adolescent↗
PubMed1995

Consultation behaviour of residents supported with a protocol processing system (ProtoVIEW) at the emergency ward.

We evaluated the consultation behaviour of residents using a protocol processing system in routine clinical practice. A total of 125 consecutive patients, of age 16 years or older with an isolated fracture without concomitant lesions, were treated with computer support between 13 October 1992 and 9 June 1993. All eight surgical residents who worked at the emergency ward of the University Hospital in Nijmegen, The Netherlands participated. The mean consultancy time, method of information retrieval, number of correct protocols found, number of windows retrieved and attitude towards ProtoVIEW as a useful information source were estimated. Main results are: a mean consultancy time of 1.5 min per case, residents browsed through the protocol information more often than using keyword search. The correct protocols were found in 98% of the cases while on average a minimum number of text-browse windows was retrieved. Residents were positive about the way protocols were presented and about the information supplied by ProtoVIEW. From this study we may conclude that ProtoVIEW consultation is hardly time consuming, and easy to use. Since keyword search was hardly used, expanding the number of synonyms may stimulate searching by keyword more often.

Adolescent↗
PubMed1983

Program development and maternal-child health consultation: a conceptual model for role enactment in developing countries.

Increasingly, nurses are serving as consultants in designing programs to improve the health of individuals in developing countries. In order to be effective, such programs must reflect the socio-cultural context in which identified health problems occur. This can become problematic when nurses work as consultants in cultures with which they are unfamiliar. This paper proposes the use of the World Health Organization's risk strategy approach as a conceptual framework for developing culture specific programs in maternal-infant health. Suggested consultant role behaviors are articulated with this approach and the various phases of program development using an ongoing project in Juarez, Mexico to which the author has provided nursing consultation as a concrete example.

Child Health Services↗
PubMed1991

Northwick Park Infection Consultation Service. Part I. The aims and operation of the service and the general distribution of infection identified by the service between September 1987 and July 1990 [see comment].

The Northwick Park Infection Consultation Service (ICS) is a collaborative service operated by the departments of Medical Microbiology and Infectious Diseases where personnel and skills are combined. Its aim is to improve the availability and effectiveness of consultation for infection-related problems. This paper sets out the framework for establishing an ICS and also details the general distribution of infection identified by the Northwick Park ICS in a study carried out between September 1987 and July 1990. Part II assesses the contribution that the ICS made to the management of infection. One thousand and thirty-eight (1038) patients were seen on the ICS. Seventy-five per cent (776) were judged to be infected and in 691 this was a probable or certain diagnosis. Skin and subcutaneous tissue, respiratory tract, and genito-urinary tract infections accounted for 64% of the total. Eighty-seven per cent of infections required treatment with intravenous antibiotics, 22% were associated with concomitant bacteraemia, and 2.7% of patients died as a direct result of their infection. Sixty-four per cent of consultations were unsolicited and arose from laboratory results or the clinical information on the form accompanying the specimen: over one quarter were initiated before results were available. These infections were no different in either severity or nature from those identified by solicited requests to either department. Fifty-three per cent of consultations had a moderate to high clinical component. The results emphasise the importance of infection in hospitals and highlight the advantages of a collaborative approach from the departments of Medical Microbiology and Infectious Diseases.

Cross Infection↗
PubMed1979

The use of the psychiatric consultation record for residency training.

The Psychiatric Consultation Record (PCR) is an instrument developed to aid in the teaching of consultation psychiatry, to evaluate the impact of this teaching, and to provide an overall assessment of the consultation training program at St. Luke's Hospital. The PCR both structures the resident's training experience and provides a tool with which he or she can integrate theoretical and practical knowledge pertaining to consultation work. Its use has enabled supervisors to detect the degree to which didactic material has become integrated into residents' thinking and has provided data through which the scope and quality of each resident's work can be rapidly assessed. Finally, its use has brought to light deficiencies in service delivery which, before the use of this instrument, had not been apparent.

Adaptation, Psychological↗
PubMed1980

A resident's rotation in consultation psychiatry. A maturational experience.

The authors emphasize the importance of a consultation psychiatry experience in the maturation of the young psychiatrist by examining some of the processes operational in both community and hospital consultation work, performed by the senior author during his fourth year of residency. Such experiences can provide opportunities for developing psychiatric skills not emphasized elsewhere, including the adoption of an active therapeutic stance, the application of the psychodynamic theory to the consultation system itself, and teaching without the use of jargon. In addition the experience as consultant facilitates the transition from residency to the outside world, not only through attitudinal changes achieved by exposure to less structured settings, a change in the supervisory model, and a solidification of identity as a physician and psychiatrist, but also by providing the resident the opportunity to begin de-cathecting from the training program.

Adult↗
PubMed1984

Making the case for consultation-liaison psychiatry: issues in cost-effectiveness analysis.

There is an increasing need to rationally allocate scarce resources to improve the efficiency of health care and reduce costs. Evidence suggests that consultation-liaison psychiatry has important clinical and economic benefits. This article defines cost-effectiveness and cost benefit analyses, describes basic principles for CEA and in that context critiques recent literature relevant to consultation-liaison psychiatry, and discusses potential contributions and dangers that such studies might offer. There is a need within the health care field for systemic and sophisticated decisions by policy makers. Well designed and comprehensively analyzed studies of the cost-effectiveness of consultation-liaison programs will not only contribute toward advancing the field of consultation-liaison psychiatry but also toward informing the decisions of health policy makers.

Cost-Benefit Analysis↗
PubMed1985

Some methodological issues in consultation-liaison psychiatry research.

This is a research methodologic design model that may be useful to consultation-liaison psychiatrists. It is intended to facilitate such researchers in setting up and executing carefully controlled studies of the effectiveness (in psychiatric, medical, surgical, functional, cost, or other areas) of consultation-liaison interventions. The specific variables discussed are areas of particular interest to the authors, but many other variables may be readily substituted into this basic model. The design may be expanded or contracted relatively easily as would be appropriate for particular projects. The overall purpose of this paper is, hopefully, to serve as a catalyst for consultation-liaison psychiatrists to consider such research in their academic settings and to foster increased discussion and critical thinking regarding such research. The authors consider such research efforts important for the future regarding the scientific basis, proven effectiveness, and funding of consultation-liaison and general hospital psychiatry.

Ethics, Medical↗
PubMed1985

Microcomputers and consultation psychiatry in the general hospital.

The microcomputer allows for the design of a system that functions integrally with both the day-to-day and long-term needs of a consultation-liaison psychiatric service. This article describes a microcomputer system and data structure that can accomplish many of the same research tasks as a minicomputer system. In addition, the same data item inputs can be used to develop management reports that can facilitate the administrative as well as the pedagogic needs of a consultation-liaison service. Because of the daily availability and review of output reports, supervisors' corrections are made that enhance the reliability of the data. The program format provides 1) an intake form with pertinent identifying demographic data; 2) an activity file that contains every encounter between the consultant and the patient as well as research, supervisory, and liaison activities (which permit cost-effectiveness analysis); 3) a master clinical data base containing 255 variables for each case seen; 4) a computer-generated chart note; 5) letters to referring physicians; 6) clinical activity descriptions for billing; and 7) a file for pertinent literature searches. Since certain analyses may be limited in the microsystem, its interactive capacity with mainframe computers allows for complex functions. The microsystem described presently emphasizes flexibility, accessibility, and step-by-step development of files as needed by a particular consultation-liaison service. Finally, microcomputers are available at a fraction of the cost of the minicomputer or mainframe systems.

Adult↗
PubMed1985

Medical and surgical inpatients who referred themselves for psychiatric consultation.

Medical and surgical inpatients who referred themselves for psychiatric consultation are characterized. The 25 "self-referred" compared to 787 "others" referred to the Consultation-Liaison Psychiatry Division were more likely to state depression (52%/25%) and anxiety (36%/11%) as reasons for referral. "Self-referrals" were less likely to be referred by physicians for behavior management (8%/23%), general diagnosis (4%/22%) or suicide evaluation (4%/25%). The "self-referral" represents a challenge to the current medical model referral mechanism in which the physician controls access to consultants. The data indicate that there should be a mechanism for the patient's contribution to the referral process and that increased sensitivity to psychologic difficulties in coping with medical illness would improve the use of psychiatric consultation in the medical setting.

Adult↗