Referral

About: Referral is a research topic. Over the lifetime, 27614 publications have been published within this topic receiving 479918 citations.

Military sexual trauma.

Abstract: Nurses' awareness of MST as a specific type of sexual assault within the military culture and sensitivity to the physical and psychological symptoms are important aspects of care. Nurses must treat the physical and emotional components of sexual assault in all settings; however, referral to the veterans administration programs and resources is key for the woman veteran to receive the specialized care developed by the healthcare system. Women veterans who have PTSD from MST and combat exposure are prone to depression, suicide and substance use/abuse. Nurses must not fear asking the woman if she is having suicidal thoughts or has a plan and intent to follow through with the plan. MST and PTSD may result in internalized anger, shame, self-blame, helplessness, hopelessness and powerlessness. Patient safety is of utmost importance. Assessing Patients for Sexual Violence, A Guide for Health Care Providers (2009) is a useful resource for nurses. The National Center for PTSD (2009) newsletter on the topic of MST includes a list of research studies. The work of Benedict (2007) and Corbett (2007) provide additional personal accounts of women soldiers who were in the Middle East conflicts. The nurse's referral to specialized services to treat MST and PTSD with evidence-based therapies is a crucial first step in the resiliency and well-being of these brave women who have served in all branches of the U.S. military.

Engineering self-organizing referral networks for trustworthy service selection

Abstract: Developing, maintaining, and disseminating trust in open, dynamic environments is crucial. We propose self-organizing referral networks as a means for establishing trust in such environments. A referral network consists of autonomous agents that model others in terms of their trustworthiness and disseminate information on others' trustworthiness. An agent may request a service from another; a requested agent may provide the requested service or give a referral to someone else. Possibly with its user's help, each agent can judge the quality of service obtained. Importantly, the agents autonomously and adaptively decide with whom to interact and choose what referrals to issue, if any. The choices of the agents lead to the evolution of the referral network, whereby the agents move closer to those that they trust. This paper studies the guidelines for engineering self-organizing referral networks. To do so, it investigates properties of referral networks via simulation. By controlling the actions of the agents appropriately, different referral networks can be generated. This paper first shows how the exchange of referrals affects service selection. It identifies interesting network topologies and shows under which conditions these topologies emerge. Based on the link structure of the network, some agents can be identified as authorities. Finally, the paper shows how and when such authorities emerge. The observations of these simulations are then formulated into design recommendations that can be used to develop robust, self-organizing referral networks.

Barriers to physicians' decisions to discuss hospice: insights gained from the United States hospice model

Abstract: Due to its comprehensive and cost-saving design, hospice has become a critical component of health care. Physicians have become the primary gatekeepers to information on hospice and sources of referral to hospice. However, many physicians do not discuss hospice options until late in the disease course, when patients and their families are no longer able to benefit from hospice services. Although physicians, as well as patients and hospice personnel, cite patient and hospice structure factors as barriers, the present article will focus on barriers physicians have more control over, such as their discomfort discussing terminality and fear of losing contact with patients. Focusing on the American hospice model, the present article will review past findings, examine gaps in the research, and propose systematic ways to discern whether the factors physicians claim are barriers actually affect their decision making about hospice referral.

Unwritten Rules of Talking to Doctors About Depression: Integrating Qualitative and Quantitative Methods

Abstract: PURPOSE We wanted to understand concordance and discordance between physicians and patients about depression status by assessing older patient’s views of interactions with their physicians. METHODS We used an integrated mixed methods design that is both hypothesis testing and hypothesis generating. Patients aged 65 years and older, who identified themselves as being depressed, were recruited from the offices of primary care physicians and interviewed in their homes using a semistructured interview format. We compared patients whose physicians rated them as depressed with those whose physicians who did not according to personal characteristics (hypothesis testing). Themes regarding patient perceptions of their encounters with physicians were then used to generate further hypotheses. RESULTS Patients whose physician rated them as depressed were younger than those whose physician did not. Standard measures, such as depressive symptoms and functional status, did not differentiate between patients. Four themes emerged in interviews with patients regarding how they interacted with their physicians; namely, “My doctor just picked it up,” “I’m a good patient,” “They just check out your heart and things,” and “They’ll just send you to a psychiatrist.” All patients who thought the physician would “just pick up” depression and those who thought bringing up emotional content would result in a referral to a psychiatrist were rated as depressed by the physician. Few of the patients who discussed being a “good patient” were rated as depressed by the physician. CONCLUSIONS Physicians may signal to patients, wittingly or unwittingly, how emotional problems will be addressed, influencing how patients perceive their interactions with physicians regarding emotional problems.