Referral

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

Effects of a Primary Care-Based Intervention on Violent Behavior and Injury in Children

Abstract: Objective. Although many major health care organizations have made recommendations regarding physicians9 roles in preventing youth violence, the efficacy of violence prevention strategies in primary care settings remains to be empirically tested. Methods. We conducted a randomized, controlled trial to evaluate the effects of an office-based intervention on children9s violent behaviors and violence-related injuries. Children 7 to 15 years of age who presented at 8 pediatric practices and scored positive on a brief psychosocial screening test ( n = 224) were randomly assigned to an intervention group (clinicians saw the screening test results during the visit and a telephone-based parenting education program was made available to clinicians as a referral resource for parents) or a control group (clinicians did not see the screening test results). Results. Compared with control subjects, at 9 months after study enrollment, children in the intervention group exhibited decreases in aggressive behavior (adjusted mean difference: −1.71; 95% confidence interval [CI]: −2.89 to −0.53), delinquent behavior (adjusted mean difference: −0.71; 95% CI: −1.28 to −0.13), and attention problems (adjusted mean difference: −1.02; 95% CI, −1.77 to −0.26) on the Child Behavior Checklist. Children in the intervention group had lower rates of parent-reported bullying (adjusted odds ratio: 4.43; 95% CI: 1.87-10.52), physical fighting (adjusted odds ratio: 1.79; 95% CI: 1.11-2.87), and fight-related injuries requiring medical care (adjusted odds ratio: 4.70; 95% CI: 1.33-16.59) and of child-reported victimization by bullying (adjusted odds ratio: 3.23; 95% CI: 1.96-5.31). Conclusions. A primary care-based intervention that includes psychosocial screening and the availability of a parenting education resource can decrease violent behavior and injury among youths.

Palliative Care Nursing: principles and evidence for practice

Abstract: Section 1: Encountering illness. Overview. History, gender and culture in the rise of palliative care. What's in a name? A concept analysis of key terms in palliative care nursing. User involvement and palliative care: rhetoric or reality? Referral patterns and access into specialist palliative care. Acute hospital care. Transitions in status from wellness to illness, illness to wellness - coping with recurrence and remission. Communication, the patient and the palliative care team. Approaches to assessment in palliative care. Section 2: Transitions into the terminal phase. Overview. Good for the soul? The spiritual dimension of hospice and palliative care. Working with difficult symptoms. Pain: theories, evaluation and management. Balancing feelings and cognitions. Working with family caregivers in a palliative care setting. Supporting families of terminally ill persons. Social death - the impact of protracted dying. Ethical issues at the end of life. A very short introduction. The impact of socialisation on the dying process. No way in: including the excluded at the end of life. Palliative care in institutions. Section 3: Loss and bereavement. Overview. Nursing care at the time of death. Loss and bereavement. The care and support of bereaved people. Bereavement support: the perspective of community nurses. Risk assessment and bereavement services. Bereavement support services. Families and children facing loss and bereavement: childhood bereavement services - a diversity of models and practices. Section 4: Contemporary issues. Overview. Professional boundaries in palliative care. The cost of caring - surviving the culture of niceness, occupational stress and coping strategies. Specialist professional education in palliative care: how did we get here and where are we going? Information and communication technology in nursing - current role and future scope. Research and scholarship in palliative care nursing. Developing expert palliative care nursing through research and practice development. Policy, audit, evaluation and clinical governance. Leading and managing nurses in a changing environment. Conclusion.

Physical activity promotion through primary health care in England

Abstract: BACKGROUND: There is increasing research supporting the argument for a beneficial link between physical activity and health maintenance and, in the past five years, this has led to a growth in physical activity promotion schemes involving primary health care. AIM: To document and critically examine the extent and nature of physical activity promotion in general practice in England. METHOD: A postal survey to all family health services authorities and primary care facilitators was conducted to identify existing and planned activity promotion schemes involving primary health care. Telephone interviews with leaders from 50 selected schemes and further detailed case studies of 11 schemes provided descriptive information of the nature of physical activity promotion. RESULTS: The initial phase revealed 157 existing schemes and a further 35 planned schemes. Two basic models of physical activity promotion were identified that were distinguishable by the primary location of the management of the patient. Practice-managed interventions (32%) involve on-site counselling to change the behaviour of patients. Leisure centre-managed projects (68%), sometimes termed 'exercise by prescription' or 'general practitioner referral for exercise' schemes, involve the identification of suitable patients and their referral to 10- to 12-week-long leisure centre based exercise induction courses. The projects in the planning stage were all of the latter type, indicating this as the favoured model. Although such schemes were generally successful in attracting patients, in all cases they involved less than 1% of the patient base from which they were drawn. CONCLUSION: There is evidence of successful recruitment, increased short-term physical activity and fitness, and improvements in the well-being of patients. However, schemes are inadequately resourced for rigorous long-term evaluation; therefore, conclusions regarding the cost-effectiveness of the two models are not possible.

Referrals from an emergency room to primary care practices at an urban hospital.

Abstract: Three hundred ninety-eight patients treated in the emergency room for non-urgent complaints who stated that they had no regular source of primary medical care were referred to one of several medical care centers in the area. Overall, 34 per cent of such patients complied with the referral. Correlates of compliance were: age (very young and very old), patient-perceived health status, medically determined need for follow-up care, and having an appointment made by the emergency room provider. Another group of 500 successfully referred patients became excellent users of the primary care office, complying with requested health maintenance and follow-up visits. However, emergency room utilization by the successfully referred patients did not decrease more than among referred patients who did not enroll in the primary care source.