Showing papers on "Referral published in 1972"

Accuracy of Predictions of Survival in Later Stages of Cancer

Abstract: Though 83% of 168 cancer patients admitted for “terminal care” died within 12 weeks of admission predictions of the probable length of survival showed little relation to the actual length of survival. A total of 83% of all “errors” were in an “optimistic” direction, the patient being expected to survive longer than he actually did. No significant differences were found between the accuracy of predictions made at referral by general practitioners, by doctors at other hospitals, by hospice physicians on the day of admission, or by ward sisters and senior nurses at the same time. A week after admission predicted and actual survival correlated more closely but predictions were still optimistic. It is concluded that predictions of the length of time which a cancer patient who is at the end of active treatment can be expected to survive should be made and interpreted with the greatest caution.

Borderlands between neurology and psychiatry: observations in a neurological hospital.

Abstract: This article describes psychiatric liaison, in its clinical and teaching aspects, at the Montreal Neurological Institute. Referral patterns are illustrated by data on 200 neurological and neurosurgical patients referred for psychiatric consultation. Our total patient material of nearly 1000 such patients seen in consultation and a joint weekly teaching session provide the basis for comprehensive discussion of the borderlands between neurology and psychiatry. It is concluded that close collaboration between these two disciplines is advantageous to both, in terms of improved clinical training of residents, identification of promising areas for interdisciplinary research, and better overall patient care. These gains justify the development of such liaison in other centers.

Who sees a psychiatrist? A study of factors related to psychiatric referral in the general hospital.

Abstract: A retrospective study was made of all patients admitted to the general wards of The London Hospital in 1968 who were coded on discharge as having a psychiatric diagnosis. Two hundred and fifty-two were selected as suitable for an investigation of factors associated with psychiatric referral. About one-third were seen by a psychiatrist and referral was found to be related to age, to type of psychiatric illness and the extent to which it was due to organic disease, to a suicidal attempt and to previous psychiatric contact. Referral rates also varied considerably between different medical consultants.

The "Sick-Role" Cycle and the Timing of Social Work Intervention

Abstract: Four questions are studied: (a) When are hospitalized persons primarily referred to hospital social workers? (b) Are there differences among referral sources in the timing of referral? (c) Are there differences in the types of social-need situations referred, depending on the timing of referral? (d) Do social workers think the timing of referral is appropriate? The findings are based on a census of 188 elderly inpatients referred to sixteen social workers at a 1,200-bed, acute-care hospital in New York City during four months in 1968. The periods describing early and late phases of hos- pitalization are conceptualized as "dependent-patient" phase (first quarter of hospitalization) and "recovery" phase (fourth quarter). A classification instrument was devised through which social workers recorded the patient's and/or family's social needs. Patients were mainly referred by doctors or family members late in their hospitalizations for social work help with posthospital planning needs.

Adrenal corticosteroids--physiological considerations.

Abstract: Appreciation of the fact that delay can be due to referral through the general practitioner has led to an attempt to bypass primary medical care in acute myocardial infarction in the Belfast coronary care scheme2 This delay operates in most parts of the British Isles, however, and further separates the patient from coronary care by a median time of 33 minutes in Doncaster It seems clear from our results, summarized in Fig 3, that the provision of a mobile coronary care unit to be alerted by general practitioners cannot be expected to contribute very much to the saving of life after acute myocardial infarction, especially in an area such as Doncaster, where ambulance delays are minimal

The effectiveness of health screening in a school program for migrant children.

Abstract: This program shows again the price paid for fragmented health services. The provision of screening teams outside of normal channels of health care resulted in the discovery of many health defects, but in the treatment of less than half of them. Several ways might be found to improve the program. At the present time we believe that an effective school health assessment can be made without physical examinations. Instead, if it is felt that heart disease should be detected in school, heart-sound screening could be added to the test battery. Teacher observation should be utilized by emphasizing the teacher-nurse conferences. This would result in referral not only of physical abnormalities, but of children with behavioral symptoms, and children with such conditions as hyperactivity and dyslexia. Such a procedure has been advocated for nearly 30 years. It would leave unsuspected hernias, which are rare, and inapparent otitis without pain, fever, or hearing loss which is probably of little significance, as the major abnormalities liable to be overlooked in health assessment. The program described here would have been far more effective had nursing time been used in the follow-up of health defects rather than in physical examinations. For instance, two of the four nurses on the screening teams might have worked with community nurses and school personnel to reach the parents. In our opinion, abandoning physical examinations and redirecting nursing time into coordination and follow-up would result in better health care for the children in the program.

The Contribution of the Psychological Evaluation to Psychiatric Diagnosis

Abstract: Summary The present study assessed the impact of psychological evaluations upon psychiatric diagnosis by comparing them with initial and final diagnoses in 137 psychiatric inpatients' records. Cases of three staff and three resident psychiatrists were studied to also determine if the psychiatrists' experience level affected the impact of reports or the kind and number of referral questions. Results indicated that the psychological report had a meaningful impact in no more than 16% of the cases, with no effect due to psychiatrists' status. The number and kind of question did differ for the two groups. Possible reasons referrals continue in the light of these data include physicians' emotional need for support and lack of appreciation of the cost involved. A rationale for psychologists handling referrals was suggested.

Management of hypochondriacal patients.

Abstract: Few patients are more difficult to manage than the endlessly complaining neurotic. Symptomatic treatment is often useless or at best temporarily beneficial. Referral to a psychiatrist is resisted. ...

Vision screening of preschool children

Abstract: Ideally, an eye examination should be performed immediately after birth and periodically during the preschool years. These years are important because it is at this time that much of a child9s relationship to his environment is being established through visual channels and treatment for visual disorders is most successful. At present, this is an impossible goal due to the large reservoir of preschool children, limited trained personnel and financial support, and lack of understanding by the publie of the importance of early eye care. As an interim measure, the most practical approach seems to be one of vision screening as part of the total health supervision of the preschool child. This would encompass children from 3 to 5 years of age and could be performed by trained paramedical personnel or volunteers with a minimum of equipment. For a successful program there must be community cooperation, approval, organization, education, and financing. A real effort must be made to contact that large group of children who are unknown to any service (physician) or agency. The screening itself has little value unless it is accompanied by adequate follow-up and resources to accept the referral and supervise the provision of proper care. CONDITIONS DETECTED BY SCREENING 1. Refractive errors. 2. Muscle imbalance. 3. Amblyopia. 4. Some eye diseases. SCREENING PROCEDURES A. Observation or history-applicable from birth. 1. Unusually large eyes, sensitivity to light, excessive tearing, cloudiness, inflammation, hemorrhage, abnormal eye movements, i.e., nystagmus. 2. Difficulty with focusing or persistent deviation of one eye after 6 months of age.

A Directory of Boston Neighborhood Health Centers

Abstract: IN August, 1970, the Office of Community Medicine at the Peter Rent Rrigham Hospital compiled a directory of Boston neighborhood health centers to serve as a referral manual for the professional staff of the hospital's Ambulatory Services Department. The response to this initial effort has been such that, one year later, more than 50,000 editions of the Directory have been distributed throughout the city, and more continue to be requested. This paper reviews the underlying process by which this hospital manual was transformed into a public-service directory and suggests ways in which it has had an impact on the health . . .

The Referring Physician and The Psychiatric Consultant

Abstract: In a general hospital setting, what patients do physicians refer to their psychiatric colleagues, and why, when and how do they go about this referral? Much of this process hinges on the physician's psychologic makeup; his attitudes toward psychiatry; and, too often perhaps, his misconceptions about psychiatric matters.

Learning disabilities--the new problem.

Abstract: Ophthalmologists are often the first referral source for the school child with a reading problem. The referring teacher or school nurse correctly assumes that an examination for eye disease should be one of the first things considered when a child is having trouble with the near tasks of vision; eg, reading. Occasionally, an ocular problem is discovered: hyperopia, iritis, congenital cataract, or hereditary macular disease. But most often, the results of complete visual analysis are normal. The next referral sources can include the child's pediatrician. Because learning disability is a heterogeneous group and various degrees of brain dysfunction may be demonstrated, both a neurological examination and an encephalogram may be necessary. 1 A psychological-educational evaluation may be done, and conferences with the school personnel usually determine the choice of treatment for the child. In some areas, a new problem has confronted the educator of school children, that of visual-perception training

Medical nurse practitioner in a neighborhood center.

Abstract: MS. SHEEDY is a medical nurse practitioner in the Terrace Village Health Center. Pittsburgh, Pa. She has a B.S. in nursing from Duquesne University, Pittsburgh. of patients of a variety of ages. In my own tremendously satisfying role, I have learned to provide primary care for people of all ages (16 and over) in a low-income housing project. In developing the role of the medical nurse practitioner (MNP) in the Te race Village Health Center, the initial model was the Northview Housing Project Health Care Program established in 1963 in Pittsburgh, Pennsylvania.' This center demonstrated that nurses could effectively perform some services usually performed by physicians. Nurses were well accepted by patients in these roles. The cost of providing primary care in the Northview Program was less than the estimated cost of similar care in an outpatient department. The Terrace Village Health Center established its pediatric care program in 1967, under the auspices of the Children and Youth Bureau of the United States Public Health Service, citizens of the community, and several local agencies. In 1970, adult care was added to the functions of Terrace Village Health Center, so that comprehensive family care could be provided. Social service, family planning, psychiatric consultations, dietary consultations, and referral to and consultations with the visiting nurse association and the health department nurses are now also offered by this family care center.

Learning disabilities--the new problem.

Abstract: Ophthalmologists are often the first referral source for the school child with a reading problem. The referring teacher or school nurse correctly assumes that an examination for eye disease should be one of the first things considered when a child is having trouble with the near tasks of vision; eg, reading. Occasionally, an ocular problem is discovered: hyperopia, iritis, congenital cataract, or hereditary macular disease. But most often, the results of complete visual analysis are normal. The next referral sources can include the child's pediatrician. Because learning disability is a heterogeneous group and various degrees of brain dysfunction may be demonstrated, both a neurological examination and an encephalogram may be necessary. 1 A psychological-educational evaluation may be done, and conferences with the school personnel usually determine the choice of treatment for the child. In some areas, a new problem has confronted the educator of school children, that of visual-perception training

Follow-up Care After Hospitalization: Health Center vs Hospital

Abstract: A study of hospitalized patients from a community with a neighborhood health center demonstrated that 39% of those who were previously registered received their follow-up care primarily from the health center after discharge from the hospital. The more frequently the health center was used prior to hospitalization, the greater its likelihood of use for follow-up care. Low referral rate to the health center by the hospital physicians probably contributed to the findings observed.