{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T18:38:21Z","timestamp":1757702301074,"version":"3.37.3"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,1,31]],"date-time":"2018-01-31T00:00:00Z","timestamp":1517356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of Washington Department of Medicine Quality and Safety award (NB)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Importance<\/jats:title><jats:p>Electronic consultation (e\u2010consult) is an important component of care for patients in the Veterans Health Administration who require subspecialty consultation but not urgent face\u2010to\u2010face evaluation. Monoclonal gammopathy of undetermined significance (<jats:styled-content style=\"fixed-case\">MGUS<\/jats:styled-content>) is a common reason for e\u2010consult. While often benign, <jats:styled-content style=\"fixed-case\">MGUS<\/jats:styled-content> requires careful evaluation and persistent surveillance over time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify areas to improve <jats:styled-content style=\"fixed-case\">MGUS<\/jats:styled-content> care delivery by e\u2010consult.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective review of our e\u2010consult database and identified a cohort of 152 <jats:styled-content style=\"fixed-case\">MGUS<\/jats:styled-content> patients triaged for e\u2010consult over a 5\u2010year period (2010\u20102014).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median time to completion of an e\u2010consult was 2\u00a0days. Ninety\u2010six percent of <jats:styled-content style=\"fixed-case\">MGUS<\/jats:styled-content> e\u2010consults had a hemoglobin &gt;10\u00a0g\/dL, and 90% had a creatinine &lt;2\u00a0mg\/dL. While the majority of e\u2010consults were low risk, paraprotein surveillance varied over time and tracked with consult utilization. With a median follow\u2010up of 44\u00a0months, there were 6 documented progression events, representing a mean rate of progression of 1% per year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>E\u2010consult is a helpful mechanism for the evaluation of <jats:styled-content style=\"fixed-case\">MGUS<\/jats:styled-content>, reducing the need for outpatient appointments. However, timely risk stratification and persistent surveillance over time are critical for e\u2010consult to work well.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ejh.13019","type":"journal-article","created":{"date-parts":[[2017,12,27]],"date-time":"2017-12-27T14:17:07Z","timestamp":1514384227000},"page":"351-355","source":"Crossref","is-referenced-by-count":6,"title":["Monoclonal gammopathies: Electronic subspecialty consultation"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8262-2994","authenticated-orcid":false,"given":"Nicholas","family":"Burwick","sequence":"first","affiliation":[{"name":"VA Puget Sound Health Care System  Seattle WA USA"},{"name":"Department of Medicine University of Washington Medical Center  Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Stein","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Washington Medical Center  Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Garcia","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System  Seattle WA USA"},{"name":"Department of Medicine University of Washington Medical Center  Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia C.","family":"Broudy","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Washington Medical Center  Seattle WA USA"},{"name":"Harborview Medical Center University of Washington  Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert E.","family":"Richard","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System  Seattle WA USA"},{"name":"Department of Medicine University of Washington Medical Center  Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,1,31]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(14)70442-5"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2010.60"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-03-1038"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-12-194241"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-12-195008"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa01133202"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2196\/medinform.4801"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2015-09-672113"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1215594"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60482-5"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.100552"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejh.12172"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/10428190600604450"},{"key":"e_1_2_6_15_1","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1182\/asheducation.V2012.1.595.3798563","article-title":"Differential diagnosis of monoclonal gammopathy of undetermined significance","volume":"2012","author":"Merlini G","year":"2012","journal-title":"Hematology Am Soc Hematol Educ Program"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2009.01.001"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.02920316"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2017.02.003"}],"container-title":["European Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fejh.13019","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ejh.13019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T21:30:57Z","timestamp":1695504657000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ejh.13019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,31]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1111\/ejh.13019"],"URL":"https:\/\/doi.org\/10.1111\/ejh.13019","archive":["Portico"],"relation":{},"ISSN":["0902-4441","1600-0609"],"issn-type":[{"type":"print","value":"0902-4441"},{"type":"electronic","value":"1600-0609"}],"subject":[],"published":{"date-parts":[[2018,1,31]]}}}