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PubMed2003

[A telemedical consultation system based on multicast].

That the multicast technology is fit for telemedical consultation application has been developed on the basis of the features analysis of medical consultation action. A scheme of the telemedical consultation application based on the multicast technology has been designed. The features of this scheme are: unrestrained joining in and quitting, simultaneous control over the transport information of doctor and patient, extending, and simulating consultation scene. And the implementation of this scheme is discussed.

Computer Communication Networks↗
PubMed1992

Prospective audit of an aminoglycoside consultative service in a general hospital.

OBJECTIVE: To investigate the impact of the introduction of a consultative service on the use, efficiency of dosing and clinical toxicology of the aminoglycoside antibiotics, gentamicin and tobramycin, in a general hospital. METHODS: Two audits were conducted six months and 18 months after the introduction of the consultative service. The audits reviewed the use of drug assay services, the adequacy of drug administration (as measured by serum antibiotic concentrations), indications for prescription, adverse outcomes (by noting markers of nephrotoxicity) and the antibiotic sensitivity of Gram-negative pathogens. The results were compared with the results of an audit conducted before the consultative service was instituted. RESULTS: There was a significant (P < 0.001 by chi 2 test) increase in the use of assays, with drug assays performed in 67% (first audit) and 77% (second audit) of aminoglycoside courses compared with 48.2% in the pre-intervention audit. Sample timing was greatly improved, with more than 70% of the samples collected at the appropriate times. Assay wastage in terms of uninterpretable assay results decreased significantly (P < 0.001) from 42.9% of total assays to 6.3% at the first audit and 3.8% at the second audit. The percentage of assay results in the desirable range increased significantly (P < 0.001) from 39.1% to 71.9% (first audit) and 75.4% (second audit). Pharmacokinetic recommendations were made in 39.1% and 64% of all aminoglycoside courses during the first and second audits respectively, with clinician acceptance of dosage recommendations at 83.1% and 82.8% respectively. For aminoglycoside courses prescribed for therapeutic reasons, 97.9% (first audit, n = 325) and 98.6% (second audit, n = 280) of indications for use were judged as clinically appropriate. The incidence of suspected aminoglycoside-induced nephrotoxicity was reduced from 8.9% of patients to 1.6% (first audit, P < 0.001) and 2.4% (second audit). Bacterial sensitivity audits showed that the great majority of clinical isolates of target organisms (n = 3523, Year 1 and n = 3385, Year 2) were sensitive to gentamicin (92.2% and 91.5% respectively) and tobramycin (98.1% and 98.8% respectively); these aminoglycosides exceeded all alternative agents in effectiveness, including first and third generation cephalosporins. CONCLUSIONS: The overall results indicate that introduction of the consultative service had a positive impact on the effective use of aminoglycosides, with a marked decrease in clinical toxicity. These influences were shown to persist for at least 18 months. The availability of reliable predictive techniques to reduce toxicity allows active promotion of aminoglycosides as the agents of choice on grounds of efficacy and economy.

Blood Specimen Collection↗
PubMed2003

[The free delivery of drugs during hospital consultations].

INTRODUCTION: In France, the access to treatment has become a priority and a right. Hence, the supply of care has been reorganised in order to improve the management of the health scourges for all the patients, whether they can pay for what they need or not. The free delivery of drugs (FDD) is part of the services offered by the public hospitals for the low income patients or those who do not yet benefit from social security coverage. As such, it is inscribed within the context of the right to treatment and is a corner stone to a new mission of the public hospital services and care networks. METHOD: The polyclinic of the Max Fourestier hospital is one of hospitals in the Paris area that supplies medical and surgical consultations to the population and provides drugs free of charge. From April 1, 1999 to the end of June 2000, all the FDD were studied for all the non-hospitalised outpatients who came to the consultations with a prescription for drugs, which could not be supplied in a pharmacy because of lack of revenues or social security coverage. RESULTS: The diseases encountered in the context of FDD were the same as those of the general population. No specificity was revealed in the prescriptions related to vulnerability. If it were necessary, this would confirm the fact that the management of persons in difficulty should be integrated in the provisions of common rights. The treatments concerned were essential, and for some persons life saving, and justifying the interest of FDD without which the health of these individuals would rapidly decline. Furthermore, this study shows the need for careful management of FDD in order to avoid the anarchical and uncontrolled delivery of several prescriptions, source of deleterious drug interactions and iatrogenia. This is the reason for the recommendation to all the staff delivering free drugs that they systematically ask the patients to meet a referring physician and contact the hospital pharmacist when necessary. COMMENTS: The FDD request is an ideal occasion for a physician to meet the patient and, because of the professional secrecy, to learn more of the patient's life style, and reveal, other than the diseases, the patients risk factors or elements of vulnerability that interact with the general state of health. The access to rights, on the occasion of FDD, is a fundamental public health strategy, since it provides the patient with access to preventive and primary care health measures. This is why we propose that FDD, other than the medical consultation, become systematically coupled with a consultation with a social care worker, to permit the rapid return of the patients to their common rights. CONCLUSION: Free drug delivery should not be conceived as a traditional pharmaceutical delivery, it should be the pretext for the reintegration of persons to their social rights and with a strategy of improved medical care. Organised in this manner, FDD is a precious tool for access to care and prevention, but also to the construction of a social relationship.

Continuity of Patient Care↗
PubMed1992

Use made by patients of chronic disease surveillance consultations in general practice.

A prospective, observational study of chronic disease surveillance consultations over a six-month period was performed in one semi-rural general practice in order to determine the content of the consultations, including incidental items not relevant to the chronic disease. At least one incidental item was recorded during 43% of consultations. There was substantial clinical content in these items: 23% of items required a prescription to be issued and 7% referral to a specialist. It is concluded that chronic disease surveillance consultations in general practice are frequently extended by patients who are anxious to discuss issues which may not be relevant to their chronic diseases. General practitioners must be sensitive to such patient expectations when they instigate chronic disease management clinics.

Adolescent↗
PubMed2004

[Teledermatological consultation].

Teledermatological consultation can be effected in two ways. One is 'store-and-forward' which involves storing photographic digital images and sending them to a consultant dermatologist who then replies by e-mail, and the other is by videoconferencing using a real time interactive audiovisual link. In daily general practice the first method is the easiest to implement. In 76-90% of cases, a diagnosis or differential diagnosis made in this way corresponds with the diagnosis made at the more usual face-to-face examination. The advantage of teledermatological consultation is that diagnosis and therapy take place faster than after regular referral and it is better than no referral at all. The referring physician should deliver data on the patient's history and physical examination in a standardized format. The same is true for the encoded personal data, the working diagnosis, and referral request. One overview and 2 detailed photos from two angles are normally taken. The overview shows the extent and localization of the skin abnormality. The patient has to consent to a teledermatological consultation. The responsibility for the treatment lies with the doctor who sees the patient face-to-face. The data that is transmitted must be encrypted or coded in such a way that it cannot be traced back to one particular person.

Adult↗
PubMed2004

[The relationship between job overload, burnout and job satisfaction, and the number of jobs of Israeli consultants].

BACKGROUND: The locus of secondary medical care provision is changing. Services that once were provided solely in hospitals are now available in the community. This and the increased competition among health plans since implementation of the National Health Insurance Law have spurred the development of community-based consultant/specialty medicine in Israel. Consequently, many consultants took part-time jobs in addition to their primary full-time job, usually in community care. OBJECTIVES: To examine the relationship between the number of jobs of the consultant and overload, burnout, and job satisfaction. METHODS: A mail survey was conducted during the latter half of 2001 among a random sample of 50% of physicians in six areas of specialization: ophthalmology, dermatology, otolaryngology, gynecology, cardiology, and general surgery. A total of 890 physicians responded to the questionnaire (response rate: 63%). RESULTS: The number of jobs and weekly work hours were independently and positively correlated with job overload and burnout. The number of jobs was negatively correlated with job satisfaction. It was found that employment as an independent physician, age, and having completed one's medical education in the former Soviet Union were negatively correlated with job overload and burnout. Employment as an independent physician, age, and an academic post were positively correlated with job satisfaction. CONCLUSIONS: Holding multiple jobs and working many hours were found to have a negative impact on the consultants' quality of work life. Enlightened employers concerned with this effect c ould consider the option of reducing or limiting the number of jobs consultants may hold.

Burnout, Professional↗
PubMed2005

Roles of medical consultants and expert witnesses in cerebral palsy litigation: a review.

What is the role of the medical consultant and expert witness during the litigation process associated with cerebral palsy (CP)? To address this question, a review was undertaken of the world literature published on CP between 1861 and 2004. The appropriate Medical Subject Heading terms were selected and used in a search of the MEDLINE, ACOGNET and Cochrane Library databases. Also, a manual search was performed. A total of 3,168 articles on CP were reviewed. Of them, 143 met the inclusion/exclusion criteria. Analysis of the pertinent articles revealed that this is the first article to address the role of the medical consultant. The literature on CP is predominantly observational studies. At best, they can be qualified as grade C in the ranking of evidence-based medicine. A clinical study on CP cannot be well designed methodologically because of ethical and technical problems. There is no literature available to determine the role of the consultant in CP cases. The appraisal of suboptimal obstetric care should not be omitted or dismissed when present. Preconceived conclusions about causation based simply on the poor outcome of a child should be avoided. A well-documented hypoxic-ischemic brain insult during the antenatal period does not automatically exclude intrapartum suboptimal obstetric care. Lack of uniformity in policies among U.S. hospitals on umbilical cord and newborn blood gas analysis (<1 hour of neonatal life), fetal membrane microbiologic cultures and placental histology creates difficult tasksfor medicolegal reviewers. Lack of vital diagnostic elements will limit the objectivity of a consultant and expert witness. The human emotional aspect plays a significant role in reaching a jury verdict for plaintiffs, regardless of the weakness of a case.

Adult↗
PubMedDate not supplied

The MPM pros answer the ten most commonly asked questions about: consultants.

The old joke is that a consultant comes to your office, borrows your watch, tells you what time it is, and then mails you a bill. The joke is funny because it is sometimes true; however, the right consultant can help you solve the right problems. Two experienced consultants tell you how to define the scope of the consultant's work, make an assessment of your internal capabilities, and determine the most appropriate way to structure payment.

Consultants↗
PubMed2006

Modelling the utility of body temperature readings from primary care consults for SARS surveillance in an army medical centre.

INTRODUCTION: There is interest in surveillance systems for outbreak detection at stages where clinical presentation would still be undifferentiated. Such systems focus on detecting clusters of syndromes in excess of baseline levels, which may indicate an outbreak. We model the detection limits of a potential system based on primary care consults for the detection of an outbreak of severe acute respiratory syndrome (SARS). MATERIALS AND METHODS: Data from an averaged-sized medical centre were extracted from the Patient Care Enhancement System (PACES) [the electronic medical records system serving the Singapore Armed Forces (SAF)]. Thresholds were set to 3 or more cases presenting with particular syndromes and a temperature reading of >or=38oC (T >or=38). Monte Carlo simulation was used to insert simulated SARS outbreaks of various sizes onto the background incidence of febrile cases, accounting for distribution of SARS incubation period, delay from onset to first consult, and likelihood of presenting with T >or=38 to the SAF medical centre. RESULTS: Valid temperature data was available for 2,012 out of 2,305 eligible syndromic consults (87.2%). T >or=38 was observed in 166 consults (8.3%). Simulated outbreaks would peak 7 days after exposure, but, on average, signals at their peak would consist of 10.9% of entire outbreak size. Under baseline assumptions, the system has a higher than 90% chance of detecting an outbreak only with 20 or more cases. CONCLUSIONS: Surveillance based on clusters of cases with T >or=38 helps reduce background noise in primary care data, but the major limitation of such systems is that they are still only able to confidently detect large outbreaks.

Adult↗
PubMed2006

[Patient satisfaction with assessment of headache by specialist consultation].

BACKGROUND: Headache is a common cause for referral of patients from a general practitioner to a neurologist. We have investigated patient satisfaction with neurological consultations for headache in Northern Norway. MATERIAL AND METHODS: We sent a postal questionnaire to all patients referred for headache from general practice to departments of neurology in Northern Norway from 1998 to 2000. RESULTS: Of 1403 patients, 942 (67%) responded to all relevant items in the questionnaire.160 of the patients were seen in Vefsn, 191 in Bodø and 591 in Tromsø. About 54% (510/942) of the patients were satisfied with the specialist consultation. Patients examined at the department in Bodø were significantly more satisfied (62 %) than patients examined in Tromsø (54%) or Vefsn (44%). Patients investigated in Tromsø reported improvement after treatment significantly more often than those seen in Vefsn. There was no difference in satisfaction between the three locations in the subgroup of patients with migraine. Patients who received a diagnosis or were given some kind of therapy were more content than others. INTERPRETATION: Almost half of the patients were not satisfied with the consultation. The degree of satisfaction varied between departments. More investigations are needed to clarify which patients with headache will benefit from a specialist consultation.

Adult↗
PubMed2006

[A descriptive study of intrahospital consultation to a neurological department].

INTRODUCTION: Intrahospital consultation (IC) is a little analyzed activity within daily neurologist hospital care. It entails an extra investment of time and resources. This study aims to describe the number and characteristics of the IC to a neurological department in our setting and to emphasize its importance within daily neurological health care. METHODS: We performed an eighteen-month retrospective study of the requests for consultations received during this period in the Neurology Service of the Hospital General Universitario. The following variables were analyzed: demographic information, number and type of IC, time of response, syndromic diagnosis, complementary tests requested and resolution of patients. RESULTS: 224 IC in 210 patients were seen. The average time of response was 1.57 days, although it was modified because of type of IC (normal: 1.7 days; for preference: 1.5 days; urgent: 0.2 days). The specialities that requested most consultations were cardiology (12.9%) and internal medicine (12.5 %). The most frequent reasons for consultation were: signs and symptoms (27.2%), focal neurological deficit (22.8%) and cognitive impairment (17.9%). CT scan and MRI were the most common complementary tests. A total of 25.4% of patients were referred to neurology outpatient clinic for follow-up. CONCLUSIONS: IC is an infrastudied activity in the literature. We consider it necessary to analyze this kind of care in every hospital in order to improve the organization and the planning of the day-to-day hospital activity

Adult↗
PubMed1991

Business analysis in occupational health and safety consultations.

We present a method for incorporating business analysis into comprehensive health and safety consultations using as an example a plant with an elevated incidence of cumulative trauma disorders. Business information, including product and management history, short- and long-term corporate goals, functional analysis, profit history, organizational structure with respect to health and safety, and personnel and labor-management relationships are evaluated simultaneously with traditional ergonomic factors. The additional business data allow consultants to identify the full scope of etiologies and make practical, credible recommendations that are more likely to be adopted by management and labor. We propose that techniques of "business analysis" be routinely incorporated into occupational health and safety consultations. However, because collection and interpretation of these data require business skills outside the occupational safety and health expert's usual repertoire, the consulting team must include participants with business expertise. We have found that occupational health medical personnel with an understanding of business analysis concepts can be very effective advocates for changes in health and safety practices. We strongly recommend incorporating methods of business analysis into the occupational health and safety curriculum.

Accidents, Occupational↗
PubMed1991

Psychiatric consultation at Srinagarind Hospital: a report on 271 cases.

The author reviewed psychiatric consultations at a teaching general hospital over a two year period. Two hundred and seventy-one patients or 0.6 per cent of all admission were referred for psychiatric consultation. The referral rate from the medical and surgical departments were higher than that of other departments. The most common psychiatric diagnosis by psychiatric consultants was delirium, followed by adjustment disorder and mood disorders. The delirious patients were significantly older than the other groups. The delirious state was commonly caused by infectious diseases, diseases of the nervous system and sense organs and disorders of fluid, electrolyte and acid-base balance. Most of the patients who had two or more active medical problems would have greater incidence of delirium. The delirious patients tended significantly to have behavior that disturbed the therapeutic environment. Among the functional psychiatric disorder patients, 22.4 per cent manifested suicide attempts as the principal reason for admission to non-psychiatric wards. The study revealed that the consultee could give the proper psychiatric diagnosis in only 18.3 per cent of the delirious group, 21.2 per cent in other organic mental disorder group and 24.6 per cent in functional psychiatric disorder group. Most of the consultees described only the psychiatric symptoms of the referred patients and did not specify the psychiatric diagnosis. The most frequently stated reason for psychiatric consultation was for proper evaluation and management.

Adolescent↗
PubMed1991

[Surgical consultation].

A consultation is a diagnostic aid aimed at obtaining an interdisciplinary consensus. Personal introspection and the necessity of consultation with physicians from other fields mark the individual limitations, which a doctor should regard. It is important to choose the right expert. The surgeon is usually called on the decide between surgical and conservative therapy. The value of consultative advice is beyond question, but qualitative and quantitative evaluation is impossible for lack of clinical studies. The results of "Second Opinion"-programs quantify differences in opinion between consulting surgeons.

Clinical Competence↗
PubMed1991

Fees charged to a consulting population in general practice.

OBJECTIVES: information generated by the computer systems of thirty-five general practitioners was examined to determine their fee structure during the study period. METHODS: copies of the general medical services (GMS) claims and patient fees were examined to determine whether patients had been charged the doctor's regular fee or an amount greater or less than this. RESULTS: information on 97,869 consultations was collected. A regular fee was charged to patients in 47% of cases, a greater or less than normal fee was charged in 7.5% of the consultations, and no fee to the patient was made in 22.5% of cases. Consultations charged to the Accident Compensation Corporation (ACC) comprised 17.5% of the study data. Maternity cases comprised the remaining 5.5%. Nineteen doctors provided information on 6511 out of hours or home visit consultations. In 44.3% of these cases no charge was made to the patient. This proportion was higher among beneficiaries (58.9%) than for any other group. CONCLUSION: all of the contributing doctors appear to exercise discretion in their charging policies rather than to maintain a rigid pricing structure for their services.

Adult↗
PubMedDate not supplied

Headache characteristics associated with physician consultation: a population-based survey.

In a population-based telephone interview survey of 9,380 Washington County, Maryland, residents 12-29 years of age who reported a headache in the prior year, only 26.7% of women and 13.6% of men had ever sought a physician's advice for a headache problem. Women (13.9%) were more than twice as likely as men (5.6%) to have consulted a doctor for this condition within the previous 12 months. The likelihood of seeking medical care for headache increased with age among women but not men. Married women were more likely to have consulted with a physician for a headache problem than single or divorced women. Men and women consulting a doctor for this disorder within the previous 12 months described recent headaches (within the prior week) that were more severe, of longer duration (women only), and more likely to have migraine characteristics than recent headaches of persons not seeking medical attention. Compared with persons never consulting a physician for a headache problem, men and women who sought medical care had elevated attack rates of certain, probable, and possible migraine and mixed migraine-tension type headaches within the preceding week. Differences in attack rates for migraine and mixed migraine-tension headaches between those who recently and those who more than 12 months ago sought a physician's advice were more striking for men than for women.

Adolescent↗
PubMed1991

Patients' views of the consultation: comparison of a prison and general practice population.

Prisoners' perceptions of why they consulted the doctor, how ill they thought they were and what happened during the consultation were studied in Bedford prison using a questionnaire. Patients' perceptions were compared before and after the consultation and with the perception of the doctor. The figures from this study were compared with comparable groups in a similar general practice survey. Prisoners perceived themselves to be more ill than comparable groups living in the community and both doctor and prisoners perceived that the prisoners received less reassurance. Prisoners were less likely to attend the doctor because their treatment had not worked, or because the doctor had asked them to return than comparable groups living in the community. The perception of the doctor and the prisoners about what occurred in the consultation diverged. The doctors perceived that they provided more advice and support than the prisoners felt they received. These perceptions may reflect a more difficult doctor-patient relationship and poorer continuity of care in prison medicine. These problems might be overcome if the prison medical service were run by the National Health Service and prison doctors had no role in the management of prisoners.

Adolescent↗
PubMed1991

Consultation in the aftermath of an air tragedy.

In the early morning hours of December 12, 1985, a chartered jet airliner carrying 248 soldiers crashed shortly after takeoff, killing all aboard. The day after, the authors were designated as a consultation team to the mental health staff at Fort Campbell who were providing services in the aftermath of the crash. This report describes and analyzes the experiences of this consultation on disaster management. Our consulting experience has been one of the most profound and demanding events of our professional lives. Salient lessons of the consultation include: (a) the need to clarify leadership roles among the local mental health care team; (b) the need to help the local team establish clear roles among team members; (c) the value of enabling the local team to mourn the loss of their fellow soldiers and community members; and (d) the value of establishing a clear plan of mental health services for both short-term and long-term management.

Aircraft↗