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[Health status of adolescents and modern approaches to holding medical professional consultations].

Due to unfavorable trends in the health state of contemporary children and teenagers, the total number of young males and females, who have health-related limitations in educational and occupational spheres, went up to 80%. A medical professional consultation belongs to a system of measures, whose purpose is to assist the young males and females with impaired health to choose professions or occupations, which would maintain their health intact and promote successfully their adaptation to professional training conditions and subsequently to actual occupational conditions. A timely and high-skilled implementation of medical professional consultations with a subsequent rational employment of teenagers and youth with impaired health should be regarded as a secondary prevention of pathologies. The holding of such medical professional consultations for teenagers is reasonable both at the stage, when a teenager makes his or her choice of a job (i.e. at school), and at the stage of receiving a professional education, so that the schoolchildren and students could get a job in line with their health status and that they could be employed with respect to doctor's recommendations. The Research Institute for Children's Health elaborated a number of methodological and regulating documents to promote the efficiency of the medical professional consultations; an automated assessment system is in the process of construction at the above institution.

Adolescent↗

[Emergencies in child clinical practice? The question of therapeutic analytic consultations].

The author analyses three analytically oriented interviews of a ten year old girl who presented a severe school phobia. These interpretation-oriented consultations helped to partly untangle the intricacies between fantasy life, childhood history and some present events in family life. Thus the symptoms could recede immediately after the consultations. Through this both frequent and illustrative case report, the author discusses the metapsychological and technical aspects concerning the legitimacy and relevance of therapeutic analytically-oriented consultations. This consultation modality can avoid the massive increase of the symptoms and of the attached secondary benefits. It enables us to take into account a certain amount of emergency in child clinical practice.

Acute Disease↗

[The specificity of organization of the consultative-and-diagnostic service for the adult population in a big city].

The volume and structure of the diagnostic services and of the medical aid appealability were analyzed for the Eastern Administrative District of Moscow by the example of a stage-2 diagnostic-and-consultative center. The analysis was made on the basis of 80233 receipts of patients for the period of January-April 2003. Three types of patients' flow were defined with respect to the purpose of visit: consultative aid (CA, 17.3%), consultative-and-diagnostic aid (CDA, 16.2%) and diagnostics (D, 66.5%). Differences are shown in the structure of appealability by the classes of diseases (nosological forms of diseases) and according to groups of patients. Consultations are mostly provided in cases of diseases of the endocrine system (20.9%), digestive system (20.2%) blood-circulation system (18.0%) and urogenital system (14.6%). Patients with urogenital disease (31.1%) and with blood-circulation lesions (13.5%) were found to be predominant in the CDA group. The structure of appealability is defined for the classes of diseases, their nosological forms and for medical specialties. It is pointed out that 52.1% of patients visited their general practitioners. Patients visited most often the doctors of the below specialties: oncology--16.1%, endocrinology and cardiology 12.3%, general practitioner--11.5% and gastroenterology--78%. The rate of visits was evaluated for the classes of diseases and medical fields; the estimated distribution of appealability was estimated with respect to the rate of visits. The structure of diagnostic examinations was analyzed by types, purpose, and classes of diseases (nosological forms).

Adult↗

Complex consultations and the 'edge of chaos'.

Complexity theory has attracted considerable attention in recent years, both within medicine and in the wider world. Its themes of uncertainty and non-linearity resonate deeply with the experience of working in general practice. Describing the consultation as a complex, adaptive system provides a coherent theoretical basis for understanding the consultation, which has so far been lacking. Understanding the consultation as a complex, adaptive system offers insights into the consultation of that may prove to be of practical use to clinicians.

Decision Making↗

[Impact of the number of antenatal consultations on the morbidity and mortality of children and women in the health district of Ziguinchor].

In order to assess the impact of the number of antenatal consultations (CPN) on the foetal and maternal morbidity and mortality, a prospective survey has been carried out in 1999, in the health district of Ziguinchor, Senegal. The investigation was led in seven health facilities which offered obstetrical cares, from January 1 to march 31, over a sample of 862 delivered women and 870 newborns. The number of antenatal consultations was zero in 26 cases (3%), one in 130 cases (15%), two in 198 cases (23%), three in 302 cases, and more than three in 206 cases (24%). Three elements of the mothers' profile have a statistically significant influence on the number of antenatal consultations: the delivery facilities, the ethnic groups, and the caesarean antecedent. For the other elements, the test is not significant. The number of antenatal consultations has a statistically significant link with: eclampsia, abruptio placentae, distich and maternal death. Some elements of the mothers' profile seem to be a cause of morbidity and mortality of children and women. In fact, we have notice: a statistically significant link between the health facilities and the dystocy; and between ethnic groups and abruptio placentae; an impossibility of drawing conclusion for the other cases. In short, the eclampsia and the maternal death are the only elements which seem to be improved by an increasing number of CPN without any influence of external factors.

Adolescent↗

Preventive activities during consultations in general practice: influences on performance.

BACKGROUND: The relationship between the performance of opportunistic preventive activities in general practice consultations and characteristics of patients, general practitioners, consultations and preventive opportunities is poorly understood. METHODS: We recorded the performance of 11 preventive care activities by 10 GPs in one practice and examined the associations of performance of the preventive activities and the characteristics of the patients, GPs, consultations and preventive opportunities. RESULTS: Every patient, GP, consultation and preventive opportunity characteristic studied was independently significantly associated with the performance of at least two of the preventive activities. DISCUSSION: These findings suggest ways of designing more effective reminders, particularly for patients least likely to receive prevention counselling.

Adult↗

Metabolic syndrome in dyslipidemia consultations.

AIMS: To evaluate the prevalence of the metabolic syndrome (MS) in dyslipidemia consultations, according to the criteria established by the National Cholesterol Education Program Adult Treatment Panel III (ATP III); to classify patients with MS according to ATP III risk categories and prevention type (primary versus secondary); and to evaluate evolution to type 2 diabetes in these patients. METHODS: A retrospective study was conducted based on analysis of the clinical records of 470 patients followed in dyslipidemia consultations at Internal Medicine II of Coimbra University Hospitals. MS was defined as the presence of three or more of the following abnormalities: waist circumference > 102/88 cm (male/female), triglyceride levels > or =150 mg/dl, HDL-cholesterol level < 40/50 mg/dl (male/female), blood pressure > or = 130/85 mmHg and fasting glucose > or = 110 mg/dl. The patients were classified into three risk categories according to the major risk factors defined by ATP III, regardless of LDL-cholesterol level. RESULTS: MS was diagnosed in 31.3% of the patients; 53.7% were male and mean age was 52.7+/-11.9 years. The most prevalent anomaly was hypertriglyceridemia (95.9%), followed by waist circumference (76.1%), HDL cholesterol (73.5%), blood pressure (69.4%) and fasting glycemia (36.7%). Based on the risk categories identified by ATP III, 30.6% of the patients had no or only one risk factor, 66.7% had multiple (2 or more) risk factors and 2.7% had coronary disease or an equivalent risk profile. 97.3% of the patients with MS were in primary prevention. 18.4% developed diabetes, the majority within 1-3 years of the first consultation. CONCLUSIONS: Our study identified a high MS prevalence in patients followed in dyslipidemia consultations, particularly in older age-groups. More than half of the MS patients had an intermediate risk profile and most of them were in primary prevention. We also found that a fifth of non-diabetic patients developed diabetes during follow-up.

Dyslipidemias↗

Guidelines for conducting a hospital-based smoker's consult service.

Thirty percent of all hospital admissions are smokers. Hospitals are quickly becoming smoke-free facilities. Individuals hospitalized for medical ailments associated with smoking might have increased motivation to quit in a smoke-free hospital. This article outlines a method to conduct a smoker's consult service. There are four treatment intervention phases: (1) consultation; (2) detoxification; (3) cessation; and (4) recovery-follow-up. The entire consultation and intervention will take approximately 2 hours. The organized smoker's consult service is a necessary component to a successful hospital-based intervention. Eliminating tobacco addiction with hospitalized patients is a movement toward the goal of a smoke-free society.

Ancillary Services, Hospital↗

Respiratory illness in children: what makes parents decide to consult?

Parents of a stratified random sample of 234 children from 21 training practices in north east England were interviewed at home. All these children had been reported in a postal questionnaire as having had a cough between six and 10 weeks before the interview. Interviews covered social characteristics of the family, the severity of the child's cough and the child's previous respiratory history. These data were analysed using the statistical technique of logistic regression. This produced a good model of consulting behaviour. The model showed that a doctor was likely to be consulted if the child had severe symptoms, or if the cough affected the child's behaviour. This suggests that most parents deciding whether to consult the doctor make careful decisions based on what they see as objective criteria. No social characteristic had a significant influence on the decision to consult the doctor over and above the influence of the characteristics and effect of the cough itself.

Adult↗

Doctor-initiated consultations: a study of communication between general practitioners and patients about the need for reattendance.

It has been suggested that general practitioners have the potential to regulate a large percentage of their workload through their control of 'doctor-initiated' consultations. A survey was made of 300 consecutive consultations in a group practice. After their consultation patients completed a questionnaire asking what advice the doctor had given them on the need to reattend. At the same time the general practitioner completed a similar questionnaire about the need for reattendance and the advice given. The general practitioners judged that 74% of patients definitely or possibly needed to reattend, and only 26% definitely did not need to reattend. The coefficient of agreement between patients' and doctors' views on whether reattendance had been recommended was only 0.41. Thus the room for control of doctor-initiated consultations is limited by both clinical considerations and the apparent difficulty of accurately communicating the doctor's advice on reattendance to the patient.

Communication↗

Development of a questionnaire to assess patients' satisfaction with consultations in general practice.

The assessment of patient satisfaction has become an important concern in the evaluation of health services. Measures of satisfaction must be valid and reliable if they are to be used widely. This paper reports the development of a new questionnaire to assess patients' satisfaction with consultations together with initial tests of the questionnaire's reliability and validity. Principal components analysis of the patients' assessments of care revealed three factors of satisfaction: the professional aspects of the consultation, the depth of the patient's relationship with the doctor, and the perceived length of the consultation. The consultation satisfaction questionnaire is reliable under the conditions of this study and may have a role in research, medical education and audit.

Consumer Behavior↗

[The use of programmed consultation and compliance with the appointment in a teaching program of family medicine. Prospective study of 2,627 cases].

During the last years, systems of programmed consultation have been included in primary health care. These allow a better knowledge and improvement of the quality of care, and an evaluation of the satisfaction degree of the population. To evaluate the performance and acceptation of a model of programmed consultation in a teaching center of Family and Community Medicine, 2627 protocolized consultations were prospectively studied. The system was shown to be accessible, and was accepted by the population. The rate of lack of compliance with the appointment was 6.4%. The variables associated with compliance were the day of the week, the type of consultation (new patient, first visit or control visit) and the number of appointments per patient. Among the causes of lack of compliance, personal ones predominated over environmental and institutional. Further studies will be required to determine the mechanisms for the improvement of the compliance with the appointment.

Appointments and Schedules↗

[Therapeutic consultation: information oriented to clinical problems].

Therapeutical information is progressively becoming more abundant, difficult to cope with and in most cases it consists on the description of drugs rather than focusing on practical problems. In medical practice, however, we are presented with multiple complex therapeutical problems and he should be able to obtain reliable information oriented to the resolution of particular clinical situations. This is practically impossible to achieve with the currently available sources. In this paper we describe a service of therapeutic consultations created with the aim of covering this need of the health care system and as a complement of other therapeutical information. This service receives consultations from different hospitals and elaborates individualized solutions. The system is computerized so that the various solutions are kept in a data base from which the information can be easily retrieved using key words. During its first four years, 525 consults regarding the following matters have been answered: selection of therapeutic strategies (29.7%), diagnosis, attitude and prognosis of adverse reactions (28.4%), documentation (11.4%), use of drugs during pregnancy (11.2%), available preparations, bibliography, interactions, pharmacokinetic, breast feeding and others. The number of consultations has increased up to date. This new service, which can be coordinated by means of a computerized data base network, participating several centers, offers a quick, reliable, direct, and individualized information oriented to particular therapeutical problems at a relatively low cost.

Drug Information Services↗

Factors associated with variation in the consultation rates of children aged under five years.

In a large urban practice, all families with a child aged under five years were identified and, after suitable exclusions, 294 (80%) of the 369 families approached cooperated in the study. For each child, the number of parentinitiated first consultations in a one-year period was extracted from general practice records, and mothers were asked to provide additional information by postal questionnaire, which included a test of the mother's reaction to a series of hypothetical child ;illness situations'.The most important factors found to be associated with higher rates of consultation were increased urgency of the mother's reaction to the test situations and attendance of the child at a pre-school group. Children with low consultation rates tended to be younger and more likely to come from larger families; their mothers generally spent less time in regular employment outside the home and were more likely to be single parents. The effect of family size was independent of maternal age and no socioeconomic gradient was found. There was also no evidence that differences in frequency of consultation were related to particular diagnostic categories. The mothers' sources of advice in the postulated event of their child becoming unwell are also described.

Adult↗

Pain in the neck, face, and head. Role of the consultation-liaison psychiatrist.

The special nature of pain in the face, head, and neck is not emphasized in the psychiatric literature on chronic pain. Although chronic pain of all types and locations share many features the psychological and symbolic significance of the head in the development of self-esteem, body image, and interpersonal relationships often confers special characteristics of pain on this area. As psychiatric consultation is not likely to be requested for patients with head, face, and neck pain in the absence of blatant "psychiatric" problems, it behooves the psychiatrist to exercise his liaison functions to enhance patient care in the inpatient setting and to help physicians recognize the utility of early psychiatric assessment on an outpatient basis with patients not yet requiring hospitalization. A collegial relationship with internists, dentists, neurologists, and surgeons facilitates the psychiatrist's role as a "team participant," often more effective in providing brief diagnostic, therapeutic, and management recommendations for patients who are usually not psychologically-minded and reluctant to pursue ongoing psychiatric treatment. However, the consultation-liaison psychiatrist can play an important role in expanding his colleagues' awareness of the multiple meanings of pain and the accompanying illness behavior, provide pedagogic help in the interviewing or history-taking process, offer suggestions about psychopharmacologic and other drug treatment, and serve as a resource for appropriate referral to sources of a variety of chronic pain treatments, including biofeedback, acupuncture, and family consultation. To fulfill both his consultative and liaison functions, it is incumbent upon the psychiatrist to be knowledgeable as well about nonpsychiatric aspects of pain of the head, face, and neck. We must acknowledge also how much we yet do not know: for example, why the psyche "chooses" a locus of pain in the body; how an external (or internal) stimulus is converted via cognitive, neuroendocrine, enzymatic, and other pathways to a somatic representation; the biochemistry of pain reduction by naturally occurring and synthetic drugs; and what characteristics distinguish the continuously creative individual who sustains persistent pain with barely an utterance from another who may "cave in" to seemingly trivial distress that results in total invalidism.

Adult↗

Sociocultural differences in patients' expectations at consultations for upper respiratory tract infection.

Among 214 patients consulting their general practitioner with upper respiratory tract infection, differences in expectation were apparent between Whites, Afro-Caribbeans and Asians. Significantly more Asians (84%) wanted prescriptions for antibiotics and/or other medication than did Afro-Caribbeans (72%) or Whites (47%) (P<O.001). There were no significant differences in terms of what was received but Asians tended to be dissatisfied with the outcome of the consultation. Self-medication before consultation was attempted by 82% of patients; 48% took two or more preparations. Afro-Caribbeans had taken significantly more preparations per person than other groups (P<0.05). Sociocultural factors may influence patients' expectations at consultations for upper respiratory tract infection.

Consumer Behavior↗

[Mineralization activity of microorganisms in refuse from medical consulting rooms and in municipal refuse].

Mineralization activity of microorganisms in refuse from consulting rooms of general practitioners, E.T.N.-specialists, dermatologists, dentists, veterinarians, and in municipal refuse was estimated by means of CO2 and NH3 measurement. In comparison to municipal refuse, the refuse from medical consulting rooms released only low amounts of CO2 and NH3. Only in refuse from the veterinarians consulting rooms relative high mineralization was found, due to specific consistency (fecal contamination) of those refuse. A slight enrichment in pepton of all refuse under test resulted in a strong enhancement of the CO2 and NH3 evolution. That effect indicates either high potential mineralization activity of microorganisms in the refuse from medical consulting rooms and their relative resistance to microbial degradation.

Ammonia↗

The reactions of patients to a video camera in the consulting room.

In a general practice survey of reactions to the presence of a video camera in the consulting room 13 per cent of patients refused to be filmed, and 11 per cent of those who did consent disapproved of recording. Patients were more willing to express their reservations about video recording if asked to fill in a questionnaire later at home rather than immediately at the surgery. Patients with anxiety, depression, or problems relating to the breasts or reproductive system were more likely to withhold consent. Patients were less likely to refuse video recording of their consultation if they were asked by the doctor for their verbal permission as they entered the consulting room rather then if they were asked to sign a consent form. Only a small minority of the patients who refused to be filmed felt that this refusal had affected their consultation with the doctor.

England↗