Showing papers on "Referral published in 1991"
Journal Article•
TL;DR: The cognitive changes associated with dementia are described, proper administration and interpretation of the Mini-Mental State Examination are explained, and a quantitative screening test of cognitive function is explained.
Abstract: Elderly patients with dementia often first come to the attention of their primary medical care providers. Evaluation of cognitive functioning is an important part of the diagnostic work-up, since dementia is a disorder defined by problems of mental or cognitive abilities. Mental status examination in the physician's office can provide diagnostically valuable information and prove useful for determining the need for referral for formal neuropsychological testing. This article briefly describes the cognitive changes associated with dementia and explains proper administration and interpretation of the Mini-Mental State Examination, a quantitative screening test of cognitive function.
288 citations
TL;DR: The referral pathways taken by 1554 patients newly referred to the mental health services in 11 countries are described, and factors associated with delays in referral are documents.
Abstract: This paper describes the referral pathways taken by 1554 patients newly referred to the mental health services in 11 countries, and documents factors associated with delays in referral. The pathways in centres relatively well provided with psychiatric staff were dominated by general practitioners and to a lesser extent hospital doctors: the relatively less well resourced centres showed a variety of pathways with native healers often playing an important part. Delays were remarkably short in all centres regardless of psychiatric resources, but in some centres we found longer delays on pathways involving native healers. Somatic problems were a common presentation in all centres, and in some centres there was a tendency for patients presenting with somatic problems to have longer delays than those with symptoms of depression or anxiety. The implications of these findings are discussed in the context of an ongoing programme of WHO research activities aimed at improving the quality of mental illness care available in community settings.
281 citations
TL;DR: The critical need for a more coherent policy on child care is explored, the barriers to developing a national child care policy are looked at, the factors in child care that are most important to children's development are evaluated, and ways of protecting children's physical well-being and fostering their development inChild care settings are examined.
Abstract: Few issues have aroused more heated public debate than that of day care for children of working parents. Who should be responsible for providing child care--government, employers, schools, communities? What types of care are best? This volume explores the critical need for a more coherent policy on child care and offers recommendations for the actions needed to develop such a policy. Who Cares for America's Children? looks at the barriers to developing a national child care policy, evaluates the factors in child care that are most important to children's development, and examines ways of protecting children's physical well-being and fostering their development in child care settings. It also describes the "patchwork quilt" of child care services currently in use in America and the diversity of support programs available, such as referral services. Child care providers (whether government, employers, commercial for-profit, or not-for-profit), child care specialists, policymakers, researchers, and concerned parents will find this comprehensive volume an invaluable resource on child care in America.
205 citations
TL;DR: This study aims to determine referral rates and intermediate and long‐term outcomes for patients consulting for menstrual disorders and referred by their general practitioner to gynaecology outpatient clinics.
194 citations
TL;DR: The findings suggest that maternal survival can be improved by the posting of midwives at village level, if they are given proper training, means, supervision, and back-up.
176 citations
Journal Article•
TL;DR: Victim recognition and referral to appropriate agencies could be improved if primary care physicians were more aware of the prevalence, severity, frequency of occurrence, and typical presentation of domestic violence.
Abstract: Domestic violence is a pervasive and frequently unrecognized cause of injury among women. We reviewed data from standardized interviews with 218 women who presented to an emergency department with injuries due to domestic violence. Victims ranged in age from 16 to 66 years and constituted a wide range of socioeconomic and ethnic backgrounds. Domestic violence often resulted in severe injury; 28% of the women interviewed required admission to hospital for injuries, and 13% required major surgical treatment. The typical presentation was injuries to the face, skull, eyes, extremities, and upper torso. A third of the cases involved a weapon, such as a knife, club, or gun. In all, 10% of the victims were pregnant at the time of abuse, and 10% reported that their children had also been abused by the batterer. Most victims (86%) had suffered at least one previous incident of abuse, and about 40% had previously required medical care for abuse. Victim recognition and referral to appropriate agencies could be improved if primary care physicians were more aware of the prevalence, severity, frequency of occurrence, and typical presentation of domestic violence.
173 citations
TL;DR: To evaluate the efficiency of birth certificate-based screening programs, 70 parents and guardians of 6- to 9-yr-old children with significant sensorineural losses were surveyed regarding their child's identification history and results indicate that children with at least one risk factor for hearing impairment were identified an average of 7.7 mo earlier than children with no risk history.
Abstract: Prompt identification of educationally significant hearing loss is yet an unattained goal. However, there is some evidence that the ability to identify and diagnose hearing loss at an early age has been significantly improved through the use of carefully designed screening protocols such as birth certificate-based high-risk registries. To evaluate the efficiency of birth certificate-based screening programs, 70 parents and guardians of 6- to 9-yr-old children with significant sensorineural losses were surveyed regarding their child's identification history. Each of these children was born in the state during the time a birth certificate-based screening program was in full operation. Results indicate that children with at least one risk factor for hearing impairment were identified an average of 7.7 mo earlier than children with no risk history. However, only 50% of the children with sensorineural hearing losses exhibited any of the risk factors and a significant number of children with risk factors were missed by the system. Had admission to a neonatal intensive care unit been considered a risk factor, 63% of the children would have exhibited at least one risk factor. More extensive implementation of high-risk registries in conjunction with more widespread education of parents and primary care providers regarding early behavioral indicators of hearing loss, procedures for referral, and appropriate intervention and management services needs to be considered.
144 citations
TL;DR: Major increases in mental health service use were observed for all levels of care during this period, and a relatively small percent of adolescents in the U.S. received any type of mentally health service in 1986.
Abstract: Shifts in the use of mental health services by adolescents between 1975 and 1986 are examined by levels of care—outpatient, partial hospitalization, residential treatment center, and inpatient. Data from National Institute of Mental Health surveys of U.S. facilities include client characteristics (age, sex, race, diagnosis, clinical history) and treatment characteristics (referral source, type of intervention, length of stay). Major increases in mental health service use were observed for all levels of care during this period. Nonetheless, a relatively small percent (less than 2%) of adolescents in the U.S. received any type of mental health service in 1986. The clinical and treatment variables available were only moderately helpful in differentiating levels of care. J. Am. Acad. Child Adolesc. Psychiatry , 1991, 30, 1:144–150.
117 citations
TL;DR: Being employed was associated with a longer delay before seeking care; among women, those living with their husbands or children had longer total intervals between the onset of the problem and arrival at the psychiatric services.
Abstract: Of 250 patients newly referred to the mental illness services of South Manchester, almost two-thirds were referred directly by their GPs; a further third were referred by hospital doctors. Non-medical sources of referral accounted for only 2% of new cases. Patients with somatic problems had the longest interval between seeking care and referral to the psychiatric services. Being employed was associated with a longer delay before seeking care; among women, those living with their husbands or children had longer total intervals between the onset of the problem and arrival at the psychiatric services.
116 citations
Journal Article•
TL;DR: The history of spirituality in healing presented in this article reflects the growth of scientific knowledge, demands for religious renewal, and the shift in the understanding of the concept of health within a broader cultural context.
Abstract: The natural science base of modern medicine influences the way in which medicine is delivered and may ignore the spiritual factors associated with illness. The history of spirituality in healing presented here reflects the growth of scientific knowledge, demands for religious renewal, and the shift in the understanding of the concept of health within a broader cultural context. General practitioners have been willing to entertain the idea of spiritual healing and include it in their daily practice, or referral network. Recognizing patients' beliefs in the face of suffering is an important factor in health care practice.
TL;DR: This article studied the referral for special education records of children and youth to identify the problems for which referrers said pupils needed help and found that 69% of the referrals were for boys, regular classroom teachers alone initiated 74% of these referrals and contributed to another 5%, and over two-thirds of students referred were in earlier grade levels, particularly kindergarten (16%), first (26%), second (15%), or third grade (11%).
Abstract: We studied the referral for special education records of children and youth to identify the problems for which referrers said pupils needed help Coders examined 382 forms used by two school systems and recorded demographic information and referrers' statements describing individual pupils' difficulties We found that (a) 69% of the referrals were for boys, (b) regular classroom teachers alone initiated 74% of the referrals and contributed to another 5%, and (c) over two‐thirds of students referred were in earlier grade levels, particularly kindergarten (16%), first (26%), second (15%), or third grade (11%) Problems most likely to be described on referral forms were general academic problems (found on 35% of referrals), reading problems (31%), and attention problems (23%) other problems such as fearfulness (2%), visual‐perceptual difficulties (1%), and depression (1%) were rarely included Factor analysis of the referral reasons revealed five common types of referrals, some of which interacted w
TL;DR: The assumptions and statistical implications of six methods of test use in em- ployment contexts were examined by using an actual distribution of test scores of 3,377 candidates for jobs as firefighters in a large U.S. city.
Abstract: The assumptions and statistical implications of six methods of test use in em- ployment contexts were examined by using an actual distribution of test scores of 3,377 candidates for jobs as firefighters in a large U.S. city. The six methods examined were: (a) strict top-down referral in order of test score; (b) within-group percentile referral; (c) fixed bands, using random referral within bands; (d) fixed bands, using nonrandom, diversity-based referral within bands; (e) sliding bands, using random referral within bands; and (f) sliding bands, using nonrandom, diversity-based referral within bands. The six strate- gies yielded significant differences on two related criteria: the percentages of minority and nonminority candidates referred for selection, and the relative level of adverse impact produced by each referral strategy. Average test scores of selectees at two different selection ratios did not differ significantly across the six referral strategies. Implications of the findings are discussed in t...
TL;DR: Evidence suggests that many children with ADD will be represented by those referred primarily for attentional deficits and learning problems, rather than those with inattention, hyperactivity, or aggression referred for child psychiatric evaluation, and referral bias does exist.
Abstract: This report examines distinctions and interrelationships among attention deficit disorder (ADD) and two closely related conditions: learning disability (LD) and oppositional/conduct (O/C) disorder. To evaluate our hypothesis that some of the difficulty in resolving the relationship between ADD and, particularly, O/C may reflect the consequences of selective referral patterns, we studied groups of children diagnosed as ADD from different referral sources. Results suggest that referral bias does exist and that children referred to mental health settings differ from those referred to pediatricians, child neurologists, or psychologists. Because of the nature of the subjects referred to mental health services, nonrepresentative associations may emerge. Rather than being considered as prototypical of all children with attention disorder, children referred to mental health facilities may represent simply an extreme of the continuum of ADD. Evidence suggests that many children with ADD will be represented by thos...
TL;DR: In this article, a model for learning key aspects of an unfamiliar culture, using the student as teacher, is presented, and special issues of technique in counseling international students are discussed.
Abstract: The special needs of growing numbers of international students and other sojourners in the US. can be addressed preventively. Confusion about American academics, customs, and interpersonal relationships may lead to loneliness and stress. Students often present to a medical provider with physical symptoms, but few accept referral to a counselor or clinician. Close teamwork among all staff serving international students is needed to lessen adjustment problems and prevent crises. Special issues of technique in counseling international students are discussed. A model for learning key aspects of an unfamiliar culture, using the student as teacher, is presented.
TL;DR: A high referral rate does not necessarily imply a high level of inappropriate referral, and doctors with particular expertise in otorhinolaryngology and ophthalmology had high referral rates to those specialties, and these differences persisted after allowing for case mix.
Abstract: OBJECTIVE--To investigate the relation between general practitioners' referral rates to individual specialties and the individual areas of expertise of the referring doctors. DESIGN--Data collected on referral patterns in one group practice over nine months. SETTING--General practice in suburban Birmingham consisting of five partners and a trainee. RESULTS--In 395 referrals there were large differences in referral patterns among partners for otorhinolaryngology, ophthalmology, general surgery, and dermatology. The doctors with particular expertise in otorhinolaryngology and ophthalmology had high referral rates to those specialties, and these differences persisted after allowing for case mix. CONCLUSION--A high referral rate does not necessarily imply a high level of inappropriate referral.
Book•
01 Apr 1991
TL;DR: Nature and Scope of Cancer Nursing, Conceptual Themes Basic to Cancer nursing, and Management of Major Clinical Nursing Problems.
Abstract: Nature and Scope of Cancer Nursing. Conceptual Themes Basic to Cancer Nursing. Cancer as a Disease. Clinical Detection and Support. Cancer Treatment: Therapies for Physical Support Approaches. Effects of Common Adult Cancers. Cancer as an Illness. Management of Major Clinical Nursing Problems. Communication, Education and Research. The Delivery of Cancer Care Services: Resources and Referral Systems. Professional Support Systems. Public Policy and Legislative Issues. Appendices.
TL;DR: In both age cohorts there was a higher incidence of spontaneous abortion among infertile women and a significantly higher proportion of younger women had sought medical help.
Abstract: A questionnaire-based study of infertility has been carried out in two age cohorts of women in a defined geographical region. Women were aged 36-40 years or 46-50 years at the time of the survey. The prevalence of infertility (no conception after 2 years of trying) was approximately 14% in both age cohorts. However, a significantly higher proportion of younger women had sought medical help. In both age cohorts there was a higher incidence of spontaneous abortion among infertile women. These findings suggest no significant increase in the prevalence of infertility over a decade but a considerable increase in the use of medical services.
TL;DR: Scope of the program includes pretransitional assessments and interventions, including education, counseling, and referral around career, postsecondary education, sexuality, and other transitional issues.
Abstract: Older adolescents are in the midst of many life changes related to physical and emotional development, education and career choices, family and peer relationships The presence of a chronic disease adds an additional burden At this stage of development, transfer of care to an adult facility becomes a major challenge for the adolescent, parents, and pediatric and adult care providers This article describes an interdisciplinary transition program from pediatric to adult health care for older adolescents with rheumatic diseases Care is transferred to an internist-rheumatologist who collaborates closely with the pediatric team Scope of the program includes pretransitional assessments and interventions, including education, counseling, and referral around career, postsecondary education, sexuality, and other transitional issues Benefits of and barriers to a structured transition program are discussed
TL;DR: The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements.
Abstract: Background. Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking. Methods. Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years. Results. Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and thos...
TL;DR: Recommendations include training for direct service staff, development of SCAN teams at service sites, and improvement of social and legal systems to address the special needs of this population.
Abstract: This article provides a comprehensive review of the State of the Art, regarding abuse of persons with disabilities as of 2/90. It provides a unique approach to defining abuse, gives statistics on incidence and prevalence, and a national review of data collection efforts. Prevention programs nationwide are scattered, and inconsistent, but represent a growing interest and implementation. Identification of abuse continues to be an obstacle, both for social service and law enforcement, who require information (date, location, perpetrator identification) that many developmentally disabled persons are unable to give. Recommendations for specialized requirements and interview approaches are given. Treatment issues include getting someone to make a referral to a clinician, then having a competent clinician available who is trained in the three areas of developmental disability, sexuality, and abuse treatment. Recommendations include training for direct service staff, development of SCAN teams at service sites, and improvement of social and legal systems to address the special needs of this population.
TL;DR: The pattern of injuries has changed over the interval between the two studies, with a higher proportion of knee injuries and a relatively lower frequency of lower leg and foot injuries, and much of this change is attributed to improvements in footwear technology.
Abstract: This retrospective study reports on 4,173 running injuries seen on referral over a 4-year period at a sports medicine clinic. Runners were grouped as recreational, marathon, or middle distance runners on the basis of their training, and data was examined for groupwise differences in age, gender, ana
TL;DR: The pressure from patients to refer reported by general practitioners is related both to general practitioners' characteristics and to the nature of the referral, which seems to explain some of the variation in referral rates.
Abstract: OBJECTIVE--To assess the effect of pressure from patients on patterns of general practitioners' outpatient referrals. DESIGN--Survey of general practitioners' referrals to hospital outpatient departments during one week. SETTING--One health district. SUBJECTS--All (160) general practitioners in the health district. MAIN OUTCOME MEASURES--Specialty of the referral, the reason for it, and its status (NHS or private) and the general practitioner's assessment of the degree of pressure exerted by the patient for the referral (much, little, or none). RESULTS--122 (76%) general practitioners completed the survey. Younger general practitioners (aged less than or equal to 45) and those qualifying in the United Kingdom and Republic of Ireland reported greater pressure from patients to refer (p less than 0.03, p less than 0.001 respectively). Pressure was also greater for patients referred privately (p less than 0.001), for those referred for reassurance (p less than 0.05), and for those referred to clinics in psychiatry, rheumatology, dermatology, and orthopaedics. General practitioners with a higher referral rate (with total consultations in the week as the denominator) were more likely to report pressure (p less than 0.01). CONCLUSIONS--The pressure from patients to refer reported by general practitioners is related both to general practitioners' characteristics and to the nature of the referral. Pressure to refer seems to explain some of the variation in referral rates among general practitioners.
TL;DR: It was considered that an alternative source of management advice on musculoskeletal problems might enable more effective use to be made of specialist orthopaedic resources.
Abstract: OBJECTIVE--To identify aspects of outpatient referral in which general practitioners9, consultants9, and patients9 satisfaction could be improved. DESIGN--Questionnaire survey of general practitioners, consultant orthopaedic surgeons, and patients referred to an orthopaedic clinic. SETTING--Orthopaedic clinic, Doncaster Royal Infirmary. SUBJECTS--628 consecutive patients booked into the orthopaedic clinic. MAIN OUTCOME MEASURES--Views of the general practitioners as recorded both when the referral letter was received and again after the patient had been seen, views of the consultants as recorded at the time of the clinic attendance, and views of the patients as recorded immediately after the clinic visit and some time later. RESULTS--Consultants rated 213 of 449 referrals (42.7%) as possibly or definitely inappropriate, though 373 of 451 patients (82.7%) reported that they were helped by seeing the consultant. Targets for possible improvement included information to general practitioners about available services, communication between general practitioners and consultants, and administrative arrangements in clinics. Long waiting times were a problem, and it seemed that these might be reduced if general practitioners could provide more advice on non-surgical management. Some general practitioners stated that they would value easier telephone access to consultants for management advice. It was considered that an alternative source of management advice on musculoskeletal problems might enable more effective use to be made of specialist orthopaedic resources. Conclusion--A survey of patients9 and doctors9 views of referrals may be used to identify aspects in which the delivery of care could be made more efficient. Developing agreed referral guidelines might help general practitioners to make more effective use of hospital services.
TL;DR: It is found that Blacks and women were more likely to attend self-help groups and the measures of social stability did not predict attendance, and persons who attended the groups had more severe problems in several domains.
Abstract: Some researchers and clinicians believe that only a fairly homogeneous subset of substance abusers are likely to affiliate with self-help groups, whereas others argue that self-help groups appeal to a wide range of persons and that selective referral of clients to self-help may be premature. This study followed 201 treated substance abusers for 6 months and found that contrary to prevailing opinion, Blacks and women were more likely to attend self-help groups and the measures of social stability did not predict attendance. In accord with other investigations, this study found that persons who attended the groups had more severe problems in several domains. Implications for clinical referral policies are discussed.
TL;DR: The need to understand more fully the determinants of early or late referral of somatization patients to a psychiatrist is indicated.
Journal Article•
TL;DR: The hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector is explored.
Abstract: This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder. Language: en
TL;DR: Closer cooperation, especially at the local level, among consultants, general practitioners, and optometrists is needed to improve testing and referral for suspected glaucoma.
Abstract: OBJECTIVE--To examine the efficiency of referral for suspected glaucoma to general practitioners and consultants by optometrists. DESIGN--A prospective survey covering 5% of all sight tests performed by optometrists in England and Wales over six months, with analysis of referred patients. SETTING--241 optometrists9 practices in areas representative of England and Wales in socioeconomic terms. SUBJECTS--Of 275,600 people attending for a sight test, 1505 were referred with suspected glaucoma (0.9% of those aged over 4%). Outcomes were recorded for 1228 patients, 1103 (90%) of whom attended for examination by a consultant ophthalmologist (8% on a private basis). The analysis was confined to the 704 cases in which the information on diagnosis was received directly from a consultant or general practitioner. MAIN OUTCOME MEASURES--Diagnoses reported by consultant ophthalmologists. Waiting times before an appointment for examination by a consultant ophthalmologist. RESULTS--Glaucoma was confirmed in 283 of the 704 referred patients, and another 222 patients were considered to require further monitoring. In all, 112 (41%) of 275 confirmed cases of glaucoma were in patients with intraocular pressures greater than or equal to 30 mm Hg. At all levels of intraocular pressure the accuracy of referral was greater when the optometrist also recorded the presence of suspicious optic discs or loss of visual field, or both; but only 331 (47%) out of the 704 referred patients had been tested with a field screener. The median waiting time for an NHS clinic appointment was nine weeks. Almost a 10th of confirmed cases of glaucoma were in people in a high risk category for glaucoma who had to wait at least 14 weeks for an appointment. CONCLUSIONS--Closer cooperation, especially at the local level, among consultants, general practitioners, and optometrists is needed to improve testing and referral for suspected glaucoma. Optometrists should be encouraged to perform all the three main tests--ophthalmoscopy, tonometry, and perimetry--in patients before referral and to report precisely on reasons for referral to help prioritisation. The optometrist9s referral letter to the general practitioner should always be passed on to the consultant. Similarly, the diagnosis should always be reported back to the optometrist.
Journal Article•
TL;DR: Assessment of pain chronicity shows a strong association with psychosocial factors and psychiatric illness includes all those pain-associated alterations in the patient's environment that reinforce illness behavior.
Abstract: Chronic pain is a problem of great public health importance that is frequently seen in the primary care setting. Pain chronicity shows a strong association with psychosocial factors. Assessment of these factors should be composed of two parts: (1) psychological factors and (2) psychiatric illness. Psychological factors include all those pain-associated alterations in the patient's environment that reinforce illness behavior. Psychiatric illness includes those syndromes that retard recovery from illness or injury, such as depression, anxiety, substance abuse, and dementia. Psychiatric and psychological interventions can be successfully introduced in the context of a comprehensive rehabilitation effort. Usually these interventions can be accomplished by the family physician in concert with a consultant psychiatrist or psychologist. In severely disabled or resistant patients, referral to a multidisciplinary pain clinic will be necessary.