Randomized controlled trial of Siberian ginseng for chronic fatigue.

BACKGROUND: Chronic fatigue greatly affects quality of life and is a common reason for consulting a physician. Since conventional therapy is often of limited help, fatigued patients may use herbal treatments. This randomized controlled trial evaluated the effectiveness of Siberian ginseng. METHOD: Subjects were recruited from advertisements in Iowa (82%) and members of chronic fatigue syndrome support groups (18%). Potential subjects were required to have substantial fatigue > or = 6 months with no identifiable cause. The mean change in a fatigue measure was compared for placebo and Siberian ginseng at 1 and 2 months. Comparisons were for all subjects and for subjects with characteristics previously identified in the literature as important for categorizing chronic fatigue. RESULTS: Ninety-six subjects were randomized to treatment groups, and 76 provided information at 2 months of follow-up. Fatigue among subjects assigned to either placebo or Siberian ginseng was substantially reduced during the study, but differences between treatment groups were not statistically significant in the full sample. Fatigue severity and duration had a statistically significant interaction with response to Siberian ginseng at the P < 0.05 level. Treatment was effective at 2 months for 45 subjects with less severe fatigue (P = 0.04 unadjusted for multiple comparisons) and for 41 subjects with fatigue for > or = 5 years (P = 0.09 unadjusted for multiple comparisons). CONCLUSION: Overall efficacy was not demonstrated. However, the findings of possible efficacy for patients with moderate fatigue suggests that further research may be of value.

Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues?

BACKGROUND: Clinical questions frequently arise during the practice of medicine, and primary care physicians frequently use curbside consultations with specialty physicians to answer these questions. It is hypothesized that well-formulated clinical questions are more likely to be answered and less likely to receive a recommendation for formal consultation. OBJECTIVE: To assess the relationship between the structure of clinical questions asked by family physicians and the response of specialty physicians engaged in curbside consultations. DESIGN AND PARTICIPANTS: A case series of clinical questions asked during informal consultations between 60 primary care and 33 specialty physicians using an e-mail service. Curbside consultation questions were sent, using e-mail, to academic specialty physicians by primary care physicians (faculty, residents, and community practitioners) in eastern Iowa. MAIN OUTCOME MEASURES: Questions were analyzed to determine the clinical task and to identify 3 components: an intervention, a comparison, and an outcome. Consultants' responses were analyzed to identify whether questions were answered and whether consultants recommended formal consultation. RESULTS: There were 708 questions in this analysis: 278 (39.3%) were diagnosis questions, 334 (47.2%) were management questions, 57 (8.0%) were prognosis questions, and 39 (5.5%) were requests for direction. Clinical questions were less likely to go unanswered or receive a recommendation for formal consultation when the question identified the proposed intervention (odds ratio, 0.54; 95% confidence interval, 0.34-0.86; P = .006) and desired outcome (odds ratio, 0.46; 95% confidence interval, 0.29-0.69; P < .001). Only 271 (38.3%) of 708 curbside consult questions identified both of these components. CONCLUSION: Medical specialists' responses to curbside consultation questions seem to be affected by the structure of these clinical questions.

Use of an E-mail curbside consultation service by family physicians.

BACKGROUND: Informal (curbside) consultations are central to clinical medicine. Typically, these exchanges between health professionals occur face-to-face or by telephone, but both of these methods can be inefficient. We created an electronic mail (E-mail) service for curbside consultations between family physicians and other health care specialists at an academic medical center. METHODS: Family physicians had access to the E-mail Consult Service (ECS) from 20 computers at three office practice sites, one hospital, and their personal offices. Informal consults could be obtained from 26 different consultants at the University of Iowa using standard E-mail. Data on the content of the consults and the use of this service were collected and both family physicians and consultants were questioned about their perceptions of the service. RESULTS: In the 18 months that the service was available, the ECS handled 237 consults. The median response time for a consult by using the service was 16.1 hours. Consultations in the area of adult medicine were the most common, followed by consults in obstetrics and gynecology. Nearly 90% of the consults were about a specific patient, and the majority of the questions were about management issues. Consultants answered 92% of the questions asked by family physicians using the ECS. Family physicians reported that this service was helpful, and most consultants reported that they enjoyed E-mail curbside consults. CONCLUSIONS: E-mail was successfully used for curbside consults. Both the family physicians and consultants found that an E-mail consultation service could be integrated into their practices.