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Referral

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


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Journal ArticleDOI
TL;DR: It is concluded that the use of structured ratings may decrease the likelihood of ethnic bias in diagnostic decisions of autism.
Abstract: This study examined (1) the distribution of ethnic minorities among children referred to autism institutions and (2) referral bias in pediatric assessment of autism in ethnic minorities. It showed that compared to the known community prevalence, ethnic minorities were under-represented among 712 children referred to autism institutions. In addition, pediatricians (n = 81) more often referred to autism when judging clinical vignettes of European majority cases (Dutch) than vignettes including non-European minority cases (Moroccan or Turkish). However, when asked explicitly for ratings of the probability of autism, the effect of ethnic background on autism diagnosis disappeared. We conclude that the use of structured ratings may decrease the likelihood of ethnic bias in diagnostic decisions of autism.

187 citations

Journal ArticleDOI
20 Sep 2006-JAMA
TL;DR: The case of a patient with a strong religious belief in a miraculous cure of metastatic pancreatic cancer is used to explore how better understanding of this belief and more explicitly spiritual conversation with the patient by his treating team might have provided opportunities for an improved plan of care.
Abstract: Spiritual issues arise frequently in the care of dying patients, yet health care professionals may not recognize them, may not believe they have a duty to address these issues, and may not understand how best to respond to their patients' spiritual needs. The case of a patient with a strong religious belief in a miraculous cure of metastatic pancreatic cancer is used to explore how better understanding of this belief and more explicitly spiritual conversation with the patient by his treating team might have provided opportunities for an improved plan of care. This article distinguishes spirituality from religion; describes the salient spiritual needs of patients at the end of life as encompassing questions of meaning, value, and relationship; delineates the role physicians ought to play in ascertaining and responding to those needs; and discusses the particular issue of miracles, arguing that expectations of miraculous cure ought not preclude referral to hospice care.

186 citations

Journal ArticleDOI
03 Sep 2014-JAMA
TL;DR: If clinicians can identify appropriate patients for weight loss efforts and provide informed advice and assistance on how to achieve and sustain modest weight loss, they will be addressing the underlying driver of many comorbidities and can have a major influence on patients' health status.
Abstract: Importance Even though one-third of US adults are obese, identification and treatment rates for obesity remain low. Clinician engagement is vital to provide guidance and assistance to patients who are overweight or obese to address the underlying cause of many chronic diseases. Objectives To describe current best practices for assessment and lifestyle management of obesity and to demonstrate how the updated Guidelines (2013) for Managing Overweight and Obesity in Adults based on a systematic evidence review sponsored by the National Heart, Lung, and Blood Institute (NHLBI) can be applied to an individual patient. Evidence Review Systematic evidence review conducted for the Guidelines (2013) for Managing Overweight and Obesity in Adults supports treatment recommendations in 5 areas (risk assessment, weight loss benefits, diets for weight loss, comprehensive lifestyle intervention approaches, and bariatric surgery); for areas outside this scope, recommendations are supported by other guidelines (for obesity, 1998 NHLBI-sponsored obesity guidelines and those from the National Center for Health and Clinical Excellence and Canadian and US professional societies such as the American Association of Clinical Endocrinologists and American Society of Bariatric Physicians; for physical activity recommendations, the 2008 Physical Activity Guidelines for Americans); a PubMed search identified recent systematic reviews covering depression and obesity, motivational interviewing for weight management, metabolic adaptation to weight loss, and obesity pharmacotherapy. Findings The first step in obesity management is to screen all adults for overweight and obesity. A medical history should be obtained assessing for the multiple determinants of obesity, including dietary and physical activity patterns, psychosocial factors, weight-gaining medications, and familial traits. Emphasis on the complications of obesity to identify patients who will benefit the most from treatment is more useful than using body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) alone for treatment decisions. The Guidelines (2013) recommend that clinicians offer patients who would benefit from weight loss (either BMI of ≥30 with or without comorbidities or ≥25 along with 1 comorbidity or risk factor) intensive, multicomponent behavioral intervention. Some clinicians do this within their primary care practices; others refer patients for these services. Weight loss is achieved by creating a negative energy balance through modification of food and physical activity behaviors. The Guidelines (2013) endorse comprehensive lifestyle treatment by intensive intervention. Treatment can be implemented either in a clinician’s office or by referral to a registered dietitian or commercial weight loss program. Weight loss of 5% to 10% is the usual goal. It is not necessary for patients to attain a BMI of less than 25 to achieve a health benefit. Conclusions and Relevance Screening and assessment of patients for obesity followed by initiation or referral of treatment should be incorporated into primary care practice settings. If clinicians can identify appropriate patients for weight loss efforts and provide informed advice and assistance on how to achieve and sustain modest weight loss, they will be addressing the underlying driver of many comorbidities and can have a major influence on patients’ health status.

186 citations

Journal ArticleDOI
TL;DR: In conclusion, young people with gender dysphoria often present with a wide range of associated difficulties which clinicians need to take into account, and the article highlights the often complex presentations of these young people.
Abstract: This article presents the findings from a cross-sectional study on demographic variables and associated difficulties in 218 children and adolescents (Mean age = 14 years, SD = 3.08, range = 5–17 years), with features of gender dysphoria, referred to the Gender Identity Development Service (GIDS) in London during a 1-year period (1 January 2012–31 December 2012). Data were extracted from patient files (i.e. referral letters, clinical notes and clinician reports). The most commonly reported associated difficulties were bullying, low mood/depression and self-harming. There was a gender difference on some of the associated difficulties with reports of self-harm being significantly more common in the natal females and autism spectrum conditions being significantly more common in the natal males. The findings also showed that many of the difficulties increased with age. Findings regarding demographic variables, gender dysphoria, sexual orientation and family features are reported, and limitations and implicatio...

186 citations

Journal ArticleDOI
TL;DR: It is suggested that physicians would benefit from additional training and education regarding safe and efficacious intervention strategies for pediatric obesity, to effectively integrate the discussion of weight issues into the primary care setting.
Abstract: The purpose of this study was to survey physicians regarding their attitudes and practices related to the treatment of pediatric obesity in a primary care setting. Surveys were sent to physicians who were members of the American Academy of Pediatrics and the American Academy of Family Physicians practicing in the Southern New England area (Connecticut, Massachusetts, and Rhode Island). The 14-item survey consisted of three main areas of focus: attitudes toward obesity, treatment and referral approaches, and barriers to addressing weight concerns in children and adolescents. Physicians estimated that 27.7% of their adolescent and 23% of their child patients are overweight. The frequency with which physicians address weight issues with both child and adolescent patients appears to increase incrementally with the patient's level of overweight. When addressing obesity, one fourth of physicians think that they are not at all or only slightly competent, while 20% report feeling not at all or only slightly comfortable. These findings suggest that physicians would benefit from additional training and education regarding safe and efficacious intervention strategies for pediatric obesity, to effectively integrate the discussion of weight issues into the primary care setting.

186 citations


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Performance
Metrics
No. of papers in the topic in previous years
YearPapers
20251
20242
20233,272
20226,893
20211,905
20201,749