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Mental health consultation in a home care agency.

A mental health nurse, educationally and clinically prepared as a specialist, can be effectively utilized as a consultant to aid nurse generalists in assessment and intervention of patients in a home health care agency. An individual staff nurse consulting with the specialist or a group of nurses provides the setting for consultant led case discussions. Consultation is a highly efficient use of specialist's knowledge and skills in health care delivery, and also provides learning opportunities for staff.

Home Care Services↗

Consultative geriatric assessment for ambulatory patients. A randomized trial in a health maintenance organization.

Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.

Aged↗

The effect of nursing consultation on anxiety, side effects, and self-care of patients receiving radiation therapy.

This study examined the effect of nursing consultation sessions on anxiety, side effects experienced, and helpfulness of self-care strategies used by patients receiving radiation therapy. Based on Orem's self-care model, it was expected that subjects in the nursing consultation group would engage in more helpful self-care strategies, have fewer and less severe side effects, and be less anxious than subjects in the other groups. Using an experimental design, 56 subjects were randomly assigned to one of three groups: control, health education, and nursing consultation. The Side Effects Profile (SEP) and Spielberger's State-Trait Anxiety Inventory (STAI) were used to collect data. Although the study findings demonstrate no significant differences among groups on all variables, an important finding was that mean state-anxiety scores were consistently lower for the nursing consultation group. This finding suggests that nurses can have a positive impact on patient anxiety at a time when anxiety is often known to interfere with patients' well-being.

Anxiety↗

Peer consultation and review.

The newly implemented clinical career structure allows for peer consultation but processes to facilitate sharing of nursing expertise are not yet in place. Here the preceptor or mentor role is compared to the experience of peer consultation in a group context. A review of the literature offers suggestions for establishing peer consultation in the clinical setting and outlines the benefits to be gained. The process of peer review is linked to the concept of peer consultation with examples of how it might be implemented at ward level. Implications for lifelong learning, professional development, professional unity and future research are outlined.

Consultants↗

Evaluation of attempted suicides: a comparative study of staff in a general hospital and consulting staff in a psychiatric hospital.

The study group consisted of medical staff (n = 53) working in the emergency department of the general hospital in Helsinki, Finland, which treats almost all self-poisonings in the area. Some of the staff in the Department of Psychiatry formed the comparison group (n = 30). The study method was an interview based on real cases of attempted suicide. The previous four cases taken for consultation by the Department of Psychiatry were chosen. The interview was based on the consultation form used in the Department of Psychiatry of Helsinki University Central Hospital. The answers of the original consultant were compared to the results from the two groups. The study group could well assess the somatic severity (lethality) of all suicide attempts, whereas the comparison group often assessed them to be more severe than the original consultant. There were no noteworthy differences between the groups concerning the assessment of the psychiatric severity (the intent to die) of the suicide attempts and the necessary after-care. The comparison group considered all suicide attempts as understandable acts, whereas there was a distribution in the results from the study group. In general, on the basis of the results, it can be said that the staff in the psychiatric hospital were significantly more cautious in their assessments than the staff at the general hospital.

Hospitals, General↗

GPs and consultants: is there agreement on patient management?

General practitioner attitude questionnaires were sent in May 1987 to 525 general practitioners (GPs) within Avon. A year later a section dealing with the management of clinical situations was sent to 198 Avon consultants, to determine how they would ideally expect a GP to respond to these situations. The majority of both the GPs and consultants held a common viewpoint, but significant differences were noted between the consultants and GPs in six out of the ten situations. Consultants with more than six months' GP experience had fewer significantly different views than their colleagues with little or no GP experience. GPs and specialists under the age of 45 years also had fewer significant differences in management than older GPs and specialists. The differences seem to reflect the clinical focus and interests of each professional group. We believe vocational training is a contributory factor to the differences and support the General Medical Council's proposal of a broader post registration training for all doctors.

Adult↗

Use of a consultant to assist a dietetic association in its media and public relations efforts.

During 1987, the Philadelphia Dietetic Association (PDA) enlisted the aid of a public relations consultant to increase media contacts and thereby accomplish a threefold goal of (a) establishing the dietetic association and its registered dietitian members as the local nutrition experts; (b) distributing reliable, current nutrition information; and (c) marketing the PDA's DIAL-A-DIETITIAN service. Through the advice of the consultant, a media tipsheet, published monthly, was created. This publication, the Nutrition Informationist, effectively increased media contacts from two in 1986 to 19 in 1987 and resulted in a total of 8 hours of air time. Weight reduction, fad diets, and sports nutrition proved to be the most popular topics. Public service announcements (PSAs) concerning the DIAL-A-DIETITIAN program were developed by the consultant to assist the public in gaining access to local registered dietitians. Calls to that service increased 75% (from an average of 47.5 to 83.0 calls) the month following the distribution of PSAs to radio stations. The positive outcome of this collaborative effort shows that public relations consultants can be a useful resource for local dietetic associations, aiding them in their efforts to reach the media and the public and to improve their image.

Consultants↗

Exemplary family physicians and consultants: empirical definition of contemporary medical practice.

To identify the characteristics of exemplary family physicians and consultants, we interviewed 25 family physicians and 25 consultants (5 each in the specialties of internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery) selected by their peers as being exemplary in their own practice setting. The results indicated that the participants had well-formulated concepts of exemplary practitioners, defining five main categories of performance: clinical competence, relationship with patients, availability, family physician-consultant relationship and a fifth category that included organizational ability and personality attributes. The family physicians and the consultants placed different values on these categories and indicated that these values might change under different clinical circumstances. Their concepts appear to be compatible with, but not restricted to, a model of contemporary medical practice based on an ethic specific to medicine.

Attitude of Health Personnel↗

Management consultant review of three departments of pharmacy to identify cost-reduction opportunities.

A review by a management consulting firm to identify cost-reduction opportunities at three hospital pharmacy departments is described. A multihospital corporation hired a management consulting firm to review the operating procedures of several departments, including pharmacy, and recommend measures for reducing costs. A team approach was adopted to enable the pharmacy department managers and the consultants to freely contribute their expertise; input was also solicited from staff members. A review of each pharmacy department's operating costs showed that drugs and i.v. supplies consumed 60-67% of the expenses, and salaries and wages 27-36%. Estimates of the full-time equivalents allocated to inpatient, clinical, support, and ambulatory and outside contract service activities were compared. The relative costs of personnel allocated to all inpatient drug distribution activities were also compared. Cost-reduction recommendations were divided into short- and long-term measures. Short-term measures involved decreasing drug expenditures, decreasing the number of personnel, and limiting decentralized services in one of the departments; savings of $500,000 were projected. Long-term recommendations involved increasing the use of technology, expanding the use of technicians, and consolidating the management staffs among the hospitals. Management consultants, in cooperation with pharmacy department managers and staff members, can identify cost-reduction opportunities without compromising patient care.

Centralized Hospital Services↗

When does the rheumatologist need surgical consultation?

The rheumatologist is in many ways dependent on the help of the surgeon, from the early diagnosis of arthritis to the treatment of old destruction. The longer the medical history of the condition, the more important its surgical treatment. Collaboration between rheumatologists and surgeons should be encouraged. It is generally best to have a rheumatologist in charge of the patient. The rheumatologist then consults a surgeon when necessary. Rheumatologists must be sufficiently well acquainted with the indications for and prospects of surgical treatment. Only then can they consult a surgeon at the right moment on the need for surgical treatment. Rheumatological treatment and consultation units should be built to allow for convenient regular orthopaedic consultation.

Arthritis↗

Toward a dialogue in international consultancy in occupational therapy with Japan as a reference.

The customs and cultural attitudes that determine occupational therapy practice cannot be transferred from one culture to another. However, the technology of occupational therapy can be transferred. The international consultant is responsible for such a technological transfer. The consultee is responsible for assimilating technology and creating a culturally appropriate treatment practice. Technological transfer in industry demonstrates that divergent cultural applications of the same technology are possible, that the autonomy of the consultee is of primary importance, and that government support of the consultation effort is crucial. Current practice and expectation in international occupational therapy consultation is examined. The author concludes that fluency in the language of the host country is a questionable expectation, and that short-term workshops by teams of therapists should supplement the traditional individual long-term consultancy. Japan is used as a reference for discussion.

Culture↗

Mental health nursing consultation: a study of expectations.

Psychiatric nurses working in the field of mental health consultation to medical-surgical nursing units may find it useful to become more fully aware of what is expected of the mental health nurse consultant role and how they can best meet these expectations in their individual situations and setting. This study demonstrated that the medical-surgical nurses in one hospital do have specific expectations for the role of the mental health nurse consultant. To fulfill these expectations the mental health nurse consultant should identify her role in light of the above findings and attempt to integrate her job within the boundaries set forth by her hospital, the nursing team with whom she is working, and the patient's needs.

Hospital Units↗

Consultation-liaison clinical psychology in modern general hospital practice.

The past few decades have witnessed rapid international development of the interface between psychiatry and the mainstream of medicine. This development, which is a characteristic of general hospital psychiatric units, has become known as consultation-liaison psychiatry and has evolved as a clinical and teaching activity dealing with psychosomatic medicine. Problems of health and illness are inextricably related to physical as well as behavioural and environmental factors, each contributing to problems encountered in the medical management of patients. Therefore as a corollary to the developments mentioned above, a new role has emerged for clinical psychology within the general hospital and has become known as 'medical psychology'. By this term is meant all the medical applications of normal and abnormal psychology. A clinical psychology consultation-liaison service in a general hospital is discussed and an analysis of 1 092 consultations and 4 193 outpatient attendances at a psychiatric unit of a general hospital between 1 January and 30 June 1982 is presented. A rationale for the role of the clinical psychologist as a consultant within the medical setting is suggested.

Female↗

[Psychiatric consultation service in a large medical clinic: evaluation over a 3-year period].

The report is based on 1,165 medical inpatients seen by the consultant psychiatrist within a 3-year period. During the last year evaluated for this study psychiatric consultation was requested for 2.8% of the total non-psychiatric hospital admissions. Questions to the consultant are most often referred to psychogenic factors, depression and suicidality. The most frequent psychiatric diagnosis was neuroses/reactions/ personality disorders followed by suicidality, organic psychoses, psychosomatic illnesses, endogenous psychoses, somatopsychic syndromes and addictions. Further details and problems in psychiatric consultation are discussed.

Depressive Disorder↗

Patient mobility and consulting behavior: a comparative study between the United Kingdom and the United States.

A study of consulting patterns of patients in the United Kingdom and the United States who had recently moved house and settled in a new environment shows that the act of moving has a notable effect on patients' health. Despite the radically different structure of the medical services in the United Kingdom and the United States, the consulting behavior of patients in contrasting settings was remarkably similar. During the first year in a new community, adults will consult twice as often as established patients with emotional illness; and during the same period of time, children will be seen twice as often with respiratory illness. The settling in period in a new environment is a time of stress, and such times of stress will be reflected by higher consulting rates and greater demand on physicians' services.

Family Practice↗

Psychiatric consultation to attorneys for abused and neglected children.

This paper summarizes the experiences and findings of a child psychiatrist as consultant to attorneys who represent abused and neglected children in court proceedings. The impact of psychiatric consultation on the attorney's legal representation of the child client are discussed. Subjects of the psychiatric consultations were 40 families containing 63 children. The attorney's representation of the child was modified in all 40 families (cases), and the initial legal representation custody plans were changed following psychiatric consultation in 21 of the 40 families.

Adolescent↗

Consultants: when to look outside for help.

Consultants not only provide an objective opinion, but they also bring complementary expertise to a nursing organization. If used appropriately, they can be both productive and cost-effective to the nursing organization. Nurse managers need to address the following issues: when to look for outside assistance; how to select the appropriate nursing consultant; what to expect from a consulting engagement; and how to evaluate the performance of a consultant.

Choice Behavior↗

[Quality assurance of pathology laboratory, standardization of surgical pathology report and consultation: recent trend].

Three recommendation articles proposed by the Association of Directors of Anatomic and Surgical Pathology in the United States were presented as to serve as the baseline of the quality assurance in the pathomorphological diagnosis. The first article was related to the internal quality assurance in the pathology laboratories. The prospective and retrospective methods were presented for daily and monthly bases. The importance of the turnaround time was stressed in addition to the reliable diagnosis. The second article was concerned about the standardization of the surgical pathology report. This was accepted nationwide in the United States like the Bethesda System in cytology. The third article covered the consultation in surgical pathology. The Association divided the consultation into personal and institutional consultations. The role of the institutional consultation has increased markedly in recent years. This is related to the new trend of the patients and their families seeking the second opinion in the clinical diagnosis. In these situations, the clinician frequently requested the new diagnostic impressions of their own pathologists. The second opinion is very important in recent practice in medicine along with informed consent. The pathologists should also be aware of these subjects.

Clinical Laboratory Techniques↗