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 1,405 records · Page 78Linked to original sources
PubMed2006

Using linguistic analysis to explore medicine counter assistants' communication during consultations for nonprescription medicines.

OBJECTIVE: The purpose of this study was to undertake linguistic analysis of consultations between medicine counter assistants (MCAs) and customers for the supply of nonprescription medicines. METHODS: The linguistic corpus comprised 168 recorded and transcribed consultations. Utterances were tagged as information eliciting, information or advice giving and other. The analysis focused on triads, beginning and ending with an MCA utterance (MCA(1)-->customer's response-->MCA(2)). The use of the mnemonic, WWHAM (Who for, What symptoms, How long, Any medicine tried, other Medication taken) was also analysed. RESULTS: A total of 505 triads were identified. Of the 773 utterances, 61% were information eliciting, 13% were information giving, 14% were advice giving and 11% were "other" or unclassifiable. No consultation involved WWHAM in its entirety. CONCLUSION: MCAs do not appear to have been made sufficiently aware of the ways in which their exchanges with customers during consultations for nonprescription medicines are crucially different from natural conversation. PRACTICE IMPLICATIONS: In order to help customers decide upon an appropriate nonprescription medicine, the MCA has the role of both informing and advising. Training should focus on informing and advising as distinct functions, and the potential problems caused by combining them.

Communication↗
PubMed2006

Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.

BACKGROUND AND PURPOSE: To estimate the prevalence of insomnia symptoms and syndrome in the general population, describe the types of self-help treatments and consultations initiated for insomnia, and examine help-seeking determinants. PATIENTS AND METHODS: A randomly selected sample of 2001 French-speaking adults from the province of Quebec (Canada) responded to a telephone survey about sleep, insomnia, and its treatments. RESULTS: Of the total sample, 25.3% were dissatisfied with their sleep, 29.9% reported insomnia symptoms, and 9.5% met criteria for an insomnia syndrome. Thirteen percent of the respondents had consulted a healthcare provider specifically for insomnia in their lifetime, with general practitioners being the most frequently consulted. Daytime fatigue (48%), psychological distress (40%), and physical discomfort (22%) were the main determinants prompting individuals with insomnia to seek treatment. Of the total sample, 15% had used at least once herbal/dietary products to facilitate sleep and 11% had used prescribed sleep medications in the year preceding the survey. Other self-help strategies employed to facilitate sleep included reading, listening to music, and relaxation. CONCLUSIONS: These findings confirm the high prevalence of insomnia in the general population. While few insomnia sufferers seek professional consultations, many individuals initiate self-help treatments, particularly when daytime impairments such as fatigue become more noticeable. Improved knowledge of the determinants of help-seeking behaviors could guide the development of effective public health prevention and intervention programs to promote healthy sleep.

Adolescent↗
PubMed2005

Death, depression and 'defensive expansion': closing down smoking as an issue for discussion in GP consultations.

This paper examines routine primary care consultations in the UK where smoking is discussed using data from a larger study of the factors influencing discussion of smoking between general practitioners (GPs) and patients. In this study, consultations have been analysed with a focus on the termination of discussion about smoking, using an approach that is informed by the conversation analytic (CA) literature on professional/client interaction. In interviews from the previous larger study, GPs suggested two main reasons for not pursuing discussion of smoking in consultations. One reason was an overarching fear of damaging the GP/patient relationship. The second reason related to clinical judgement, where it was feared that an attempt to stop smoking might exacerbate a patient's existing condition, particularly their mental health. This paper suggests that, while this latter scenario of clinical judgement is borne out by the consultation data, there are two more subtle patient behaviours which are associated with GPs abandoning further discussion of smoking: patients' 'troubles telling', where the issue of smoking is de-emphasised in the face of other 'troubles', and 'defensive expansion', where the patient over-emphasises deficiencies to curtail discussion. Greater awareness of the situations in which doctors end discussion of smoking will help GPs to develop ideas for alternative approaches in these circumstances which could result in more meaningful, effective engagement between doctors and their patients who smoke when smoking is discussed.

Death↗
PubMed1998

Early experience using telemedicine for neonatal surgical consultations.

BACKGROUND/PURPOSE: Telemedicine affords the opportunity to extend the presence of surgical evaluation to centers without an on-site pediatric surgeon. However, concern for cost, accuracy of diagnosis, and physician acceptance have limited its use. METHODS: Using a low-cost, desktop computer-based system, this study was designed to test the effectiveness of telemedicine in neonatal surgical consultation. RESULTS: Early experience with six video-teleconference (VTC) and six store-and-forward consultations are presented. Diagnosis was established accurately in all cases. With the three intestinal cases (jejunal atresia, duplication cyst, and r/o malrotation), diagnostic studies were guided by the images transmitted with the consult. Earlier care could be implemented in other cases. Technical problems were encountered primarily with the VTC modality, which also proved more consuming of physician time. CONCLUSIONS: Telemedicine was used successfully in each case and proved accurate in diagnosis and guiding further evaluation. This is the first report of the use of telemedicine for surgical consultation in the intensive care nursery.

General Surgery↗
PubMed2001

The influence of health beliefs on the presentation and consultation outcome in patients with chemical sensitivities.

OBJECTIVE: This study was carried out to investigate the impact of the physical effects of a chemical exposure, health and chemical beliefs, and chemical sensitivities treatment preferences on the consultation outcome at a tertiary liaison clinic. METHOD: Eighty-five patients exposed to a range of chemicals were assessed at a joint medical toxicology and psychiatric clinic. Patient's beliefs about chemicals and health, chemical sensitivities and their treatment preferences were assessed using a 23-item questionnaire. RESULTS: Fifty-seven patients (69%) had suffered from a range of initial or delayed symptoms that were probably a clear physical consequence of the exposure (Group A), whereas 26 patients (31%) had not (Group B). There were no significant differences found between groups A and B in terms of their diagnosis and their beliefs about health, food, chemicals and chemical sensitivities treatment preferences. However, patients in Group A were significantly more likely to report moderate to severe symptoms in comparison to Group B. Consultation outcome too did not differ between the two groups. The only predictors of consultation outcome were the patients' chemical sensitivities treatment preferences. Patients who at the outset thought that their treatment should comprise of complete avoidance to chemicals, regular monitoring and the use of alternative rather than conventional medicine were significantly less likely to achieve a favourable consultation outcome. Patients' chemical sensitivities treatment preferences were related to the more general beliefs on health, food and the harmful nature of chemicals and were not related to the chemical exposure variables. CONCLUSION: These findings suggest that addressing patients' treatment preferences and the general beliefs on chemicals, food and health may enhance outcome and perhaps ought to be the target for intervention in context of such a liaison clinic.

Adult↗
PubMedDate not supplied

Psychiatric comorbidity among hospitalized AIDS patients vs. non-AIDS patients referred for psychiatric consultation.

Data were collected on 3,420 psychiatric consultations from July 1, 1989, to January 1, 1994, of which 675 were for patients identified as infected with the human immunodeficiency virus (HIV). Comparisons of psychiatric comorbidity among persons with AIDS (PWAs), HIV+ asymptomatic patients, and non-HIV patients were made. Dementia was a significantly frequent comorbid diagnosis among the referred PWAs compared with the general consultation population and was related to older age. Psychiatric comorbidity among the referred HIV+ asymptomatic patients more closely resembled the general consultation population. Major depression was relatively rare among the PWAs. The authors believe that the large sample size of this study allows for an accurate representation of the psychiatric disorders found among medically ill HIV patients in an urban hospital who are referred for psychiatric consultation.

AIDS Dementia Complex↗
PubMed1989

A comparative study between the use of analgesia/anaesthesia and of episiotomy in women delivered under consultant supervision or general practitioner care.

A retrospective cohort study based on obstetric records was performed, to compare the use of analgesia/anaesthesia during labour by consultants and general practitioners. The episiotomy rates for the two groups were also compared. 111 general practitioner patients were identified and these were matched with 111 consultant patients. No difference was found between the two groups for duration of stages I or II. The rates for episiotomy, 1 degree or 2 degrees tear or intact perineum were the same in each group. Women delivered under consultant supervision used more entonox than women delivered under general practitioner care, but this was counterbalanced by an increased use of pethidine in the latter group. No difference was found between the two groups with regard to the use of epidurals. There was an increased use of local anaesthetic by general practitioners. This was due to general practitioners preferring to use local anaesthetic for suturing after an epidural had worn off, whereas hospital doctors preferred to top-up the epidural to provide anaesthesia for suturing. This study supports the view that women delivered under the care of their own general practitioner in a hospital obstetric unit fare no worse than similar women delivered under consultant supervision. The former group have the advantage of continuity of care from their general practitioner.

Anesthesia, Obstetrical↗
PubMed1995

Effectiveness of joint consultation sessions of general practitioners and orthopaedic surgeons for locomotor-system disorders.

Joint consultation sessions between general practitioners (GPs) and specialists to examine patients for whom decisions about referral are difficult are thought to be helpful, but their effects have not been evaluated. In a randomised, controlled trial we studied the effects of joint sessions of GPs and orthopaedic surgeons on referral and intervention rates. During 1.5 years, 12 GPs (in groups of three) held monthly joint consultation sessions with four participating orthopaedic surgeons: patients were seen by one orthopaedic surgeon in the presence of three GPs. Patients were included in the trial if the GP was uncertain about the diagnostic or therapeutic management and if referral was considered; and excluded if referral was urgently necessary or if there was some other clear indication for referral. By a randomised consent design, patients were assigned to joint consultation sessions (n = 144) or a usual-care control group (n = 128). A year later the patients were examined by an independent orthopaedic surgeon. There were significantly fewer referrals (51/144 [35%] vs 87/128 [68%], p < 0.01) and diagnostic actions in the intervention group than in the control group, without negative effects on health or functional status. More patients in the intervention group were symptom-free at 1 year (35% vs 24%, p < 0.05). Joint consultation sessions of GPs and orthopaedic surgeons within the framework of general practice resulted in more efficient care, with better targeted examination, treatment, and referrals.

Family Practice↗
PubMedDate not supplied

The association of suicide attempts and comorbid depression and substance abuse in psychiatric consultation patients.

Substance abuse has been associated with attempted suicide and suicide. Few studies have examined the prevalence and associations of combined depression and substance abuse in suicide attempters. A chart review study of 1136 adult general hospital patients referred for psychiatric consultation between 1995 and 1998 was conducted to assess this further. Among 371 cases with self-harm, 311 (84%) attempted suicide. Suicide attempters were younger and diagnosed more often with comorbid substance abuse than patients without self-harm. Depressive disorders were found in 59% and substance abuse disorders in 46%. Comorbid depression and substance abuse was the most frequent category in suicide attempters, i.e., in 37%. Self-reported suicide intent was associated with increasing age, male gender, and comorbid depression and substance abuse. The suicide rate in suicide attempters was 322 per 100,000 patient-years, and 131 per 100,000 in consultation patients without self-harm. It is concluded that comorbid depression and substance abuse is associated with attempted suicide in psychiatric consultation patients. Suicide attempters should be thoroughly assessed for substance abuse. The increased suicide rate in psychiatric consultation patients with and without suicide attempts warrants further research.

Adult↗
PubMedDate not supplied

Consultation-Liaison psychiatric service delivery: results from a European study.

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.

Adult↗
PubMedDate not supplied

Changes in psychiatric consultations over ten years.

We report on the day-to-day functions of a consultation-liaison psychiatric service during a two-month period separated by ten years. As general hospitals transformed their delivery of services during the 1990s, we hypothesized that the day-to-day role of the consultation-liaison service would change in terms of the population served, timing of evaluations, and recommended interventions. Using a chart review, we retrospectively examined consultations referred to an adult consultation-liaison service at a university hospital during the same two-months in 1990 (N=75) and 2000 (N=90). Patients in 2000 were less educated, more likely to be divorced and more likely to be minorities. The 2000 patients appeared to have more severe psychiatric illness and to be more medically complicated. These findings have implications in the context of cost effective health care.

Adult↗
PubMedDate not supplied

Active engagement in the consultation process.

This paper presents a case for the active, dynamic engagement of patients during consultations. Observations and hypotheses about the patient's predominant conflicts are used to formulate interventions early in the consultation process that are designed to convey meanings that make the patient's experience comprehensible to him. This includes attention to his personality and his world view. The activity of the consultant in appropriately communicating aspects of these formulations to the patient is designed to facilitate the process of self-revelation and to permit a co-construction with the patient of a perspective on aspects of his life experience and his current problems. Active, dynamic engagement leads to the development of a bond between consultant and patient that facilitates the implementation of a treatment plan. Numerous case descriptions are included to illustrate this active approach as applied in different contexts.

Humans↗
PubMed2003

Devising and establishing the face and content validity of explicit criteria of consultation competence in UK primary care nurses.

AIM: The aims of this study were (a) to devise a set of prioritised criteria of consultation competence which primary care nurses need to acquire and (b) to determine the face and content validity of these criteria. METHOD: The criteria of consultation competence as contained in the Leicester Assessment Package (LAP) were modified for use with primary care nurses and sent to a stratified sample of UK primary care nurses (n=1126) to determine their face and content validity. RESULTS: Support for the seven categories of consultation competence varied from 93-98% and for the 39 component competences from 88-98%. There was no consensus for alternative or additional categories or components. CONCLUSIONS; We have established the face and content validity of the derived competences. These are suitable for the teaching and assessment of consultation skills of primary care nurses, at all stages of their professional development, when incorporated within an educational package.

Clinical Nursing Research↗
PubMed1996

Nurse education consultancy: a new role.

Market philosophy is transforming nurse education, an arena where alternative values and beliefs have been important. Such philosophy challenges nurse teachers to rethink their roles and consider what they might have to offer the profession either working within an institution or independently. This paper will explore the role of the nurse education consultant, examining what is implied by the term 'consultation' and what this might mean within a consultation process. Consultancy may be used to help colleges to market effectively and ethically, when the benefits of long term investment in education may not otherwise be apparent.

Consultants↗
PubMed2003

What are the ingredients for a successful evidence-based patient choice consultation?: A qualitative study.

The evidence-based patient choice (EBPC) approach is one of a number of newly emerging templates for medical encounters that advocate evidence-informed choice and shared decision-making. These models emphasise respect for patient preferences for involvement in health care decisions and advocate the sharing of good quality evidence-based information. In the medical consultation EBPC involves providing patients with evidence-based information in a way that facilitates their ability to make choices or decisions about their health care. Whereas the key principles of shared decision-making have been conceptualised, so far, no qualitative investigations have been undertaken to establish the key components of an EBPC consultation. Therefore, a series of semi-structured interviews were carried out with key informants to identify the elements and skills required for a successful EBPC consultation to occur. The interviews were conducted with purposively selected UK general practitioners (n=11), hospital doctors (n=10), practice nurses (n=5), academics (n=11) and lay people (n=8). Qualitative analysis of participants' responses was conducted using the constant comparative method. Six main themes emerged from the data, these were research evidence/medical information, the doctor-patient relationship, patient perspectives, decision-making processes, time issues and establishing the patient's problem. All respondents placed importance on doctors and patients being well informed and appraised of the latest available medical evidence. There was a general view that evidence-based information regarding diagnosis and treatment options should be shared with patients during a consultation. However, there were no suggestions as to how this might be achieved in practice. Participants' opinions relating to which model of decision-making should be adopted ranged from favouring an informed choice model, to the view that decision-making should be shared equally. Similarly, there was no clear view on how much guidance a doctor should offer a patient during decision-making concerning the most appropriate treatment option for that patient.

Attitude of Health Personnel↗
PubMed2003

"I'll give up smoking when you get me better": patients' resistance to attempts to problematise smoking in general practice (GP) consultations.

This paper focuses on general practice consultations where the issue of patients' smoking is raised and problematised by general practitioners (GPs) by linking it to their presenting or ongoing medical conditions. The data are taken from a larger study in one country of the UK, of the factors influencing discussion of smoking between GPs and patients who smoke. Consultations have been examined informed by the conversation analysis literature, with a focus on patients' resistance to doctors' problematisation of smoking. It is argued that, despite evidence from other areas of health care that advice is most effective when it is personalised, and despite GPs' expressed views that a preferred way of topicalising smoking is to make links to a patient's current medical problems, this is not generally the case in these consultations. Linking smoking to current problems commonly results in explicit resistance from patients of a kind that is rarely seen in other medical consultations. It is postulated that this results from the moral implications of linking a person's health status with their own behaviour, thereby undermining their claim to legitimate illness and to medical help.

Family Practice↗
PubMedDate not supplied

Time analysis of consult service emergency department admission process compared with emergency medicine service admission process.

This prospective case-controlled study was performed to compare the time intervals of a consult emergency department (ED) admission process with an emergency medicine (EM) service admission process. During March 1994, the consultant services admitted 307 patients for hospitalization at an urban tertiary academic ED with an EM residency; in April 1994, the EM service admitted 264 patients. The times measured were: 1) triage to examination room; 2) room to first physician contact; and 3) emergency physician contact to admit request. Data analysis was by mode and Wilcoxon tests. We analyzed 537 evaluable admissions. The mode for consultant process was 205 min, and the mode for emergency medicine admissions was 158 min from first physician contact to admit request, for a 47-min difference. All patients arrived stable to an inpatient bed; none was transferred to the Intensive Care Unit or to an operating room in the first 24 h. Concordance of the ED admitting impression and the hospital discharge diagnosis was 99% (259/264). We conclude that in selected tertiary academic EDs, admission of all patients by the EM service is more efficient than a consultant-admission process. Outcomes show the EM admission process may be employed safely and with accurate patient diagnosis.

Consultants↗
PubMed2001

A comparison of videotape and audiotape assessment of patient-centredness in family physicians' consultations.

The aim of this study was to compare videotape and audiotape assessments of doctors' patient-centred behaviour in primary care consultations. The patient-centredness scale of Henbest and Stewart was used to measure the quality of 856 doctor-patient interactions in 258 consultations performed by 47 primary care physicians recorded on videotape. Assessments were performed once using only the sound track and a second time using both the sound and video-tracks. On a nominal quality scale of 0-3, the average score for all consultations was 1.94 (S.D. 0.63) by audio assessment, and 1.94 (S.D. 0.59) by video assessment (P<0.8). There was excellent agreement between audio and video scores over a wide range of scores. Little information (<5%) was lost when using audiotape compared to videotape. It was technically easier to assess the video recordings. Audio recording is equivalent to video recording for the assessment of patient-centredness using the scale of Henbest and Stewart in primary care consultations.

Data Collection↗