Topic
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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TL;DR: In this paper, the authors compared differences in mortality and the duration of hospitalization in patients with chronic kidney disease who are referred early versus late to nephrologists and found that there was significantly increased overall mortality in the late referral group as compared with the early referral group.
179 citations
TL;DR: The novel, integrated data presented here provide three recommendations for improving care in line with policy directives: sensitive provision of information and discussion of end-of-life issues with patients and families; mutual education of cardiology and palliative care staff; and mutually agreed palliatives care referral criteria and care pathways for patients with CHF.
Abstract: Objective
Although chronic heart failure (CHF) has a high mortality rate and symptom burden, and clinical guidance stipulates palliative care intervention, there is a lack of evidence to guide clinical practice for patients approaching the end of life. This study aimed to formulate guidance and recommendations for improving end of life care in CHF. The objectives were to generate data on patients and carers? preferences regarding future treatment modalities, and to investigate communication between staff, patient and carer on end of life issues. Design
Semi-structured qualitative interviews were conducted with 20 CHF patients (New York Heart Association functional classification III-IV); 11 family carers; 6 palliative care clinicians and 6 cardiology clinicians.
Setting
A tertiary hospital in London, UK. Results
Patients and families reported a wide range of end of life care preferences. None had discussed these with their clinicians, and none were aware of choices or alternatives in future care modalities, such as adopting a palliative approach. Patients and carers live with fear and anxiety, and are uninformed about the implications of their diagnosis. Cardiac staff confirmed that they rarely raise such issues with patients. Disease specific and specialism-specific barriers to improving end of life care were identified. Conclusions
This novel, integrated data provides three recommendations for improving care in line with policy directives: sensitive provision of information and discussion of end of life issues with patients and families; mutual education of cardiology and palliative care staff; and mutually agreed palliative care referral criteria and care pathways for CHF patients.
179 citations
TL;DR: The authors reviewed current practices in urban school districts related to referral and placement of academically low-functioning children in special education and found that today's child with learning disabilities functions very similarly to the way students with educable mental retardation performed 25 years ago.
Abstract: We review current practices in urban school districts related to referral and placement of academically low-functioning children in special education. Data we have collected over a 10-year period indicate that today's child with learning disabilities functions very similarly to the way students with educable mental retardation performed 25 years ago. We discuss the characteristics and needs of inner-city special education youngsters and the difficult options facing school administrators.
178 citations
TL;DR: Parents of chronically ill children report a seriously lower health-related quality of life, which should receive attention and supportive care if necessary, and a family-centered approach in pediatrics is recommended.
Abstract: CONTEXT. The number of parents who care for a chronically ill child is increasing. Because of advances in medical care, parental caring tasks are changing. A detailed description of parental health-related quality of life will add to the understanding of the impact of caring for a chronically ill child. This will contribute to pediatric family care. OBJECTIVE. Our goal was to determine the health-related quality of life of parents of chronically ill children compared with parents of healthy schoolchildren. DESIGN, SETTING, AND PARTICIPANTS. A survey of 533 parents of children with chronic conditions (10 diagnosis groups, children aged 1–19 years, diagnosed 1 year ago, living at home) and 443 parents of schoolchildren was conducted between January 2006 and September 2007. Parents were approached through Emma Children’s Hospital (which has a tertiary referral and a regional function) and through parent associations. The comparison group included parents of healthy schoolchildren. Healthrelated quality of life was assessed with the TNO-AZL Questionnaire for Adult’s Health Related Quality of Life. MAIN OUTCOME MEASURE. Health-related quality of life measures gross and fine motor function, cognitive functioning, sleep, pain, social functioning, daily activities, sexuality, vitality, positive and depressive emotions, and aggressiveness. The healthrelated quality of life of the study group was compared with that of the comparison group, and effect sizes were estimated. The percentages of parents at risk for a low health-related quality of life were compared with the 25th percentile scores of the comparison group. RESULTS. Parents of chronically ill children had a significantly lower health-related quality of life. Subgroup analysis showed lower health-related quality of life on sleep, social functioning, daily activities, vitality, positive emotions, and depressive emotions in disease-specific groups. On average, 45% of the parents were at risk for health-related quality-of-life impairment. CONCLUSIONS. Parents of chronically ill children report a seriously lower health-related quality of life, which should receive attention and supportive care if necessary. A family-centered approach in pediatrics is recommended. Pediatrics 2008;122: e1030–e1038
178 citations
TL;DR: Assessments of psychological factors showed that initial attitudes of denial, conscious fighting of disease, and optimism were linked with increased late admissions; earlier awareness of dying in patients and stoicism in relatives favoured home deaths.
Abstract: The factors related to admission of patients with terminal cancer who had been referred to a reputable home care service were examined in 415 patients referred in a two-year period and in a prospective study of a randomized one in three sample of the 232 adults still alive one week after referral, who were able to converse and be at home with caring relatives. The reasons given by staff for intermediate admissions were mostly to improve symptom control or provide respite; for final admissions the reasons were symptom control, patients' deteriorated state and relatives needing relief. Independent weekly assessments usually concurred in showing increasing problems or distress preceding final admission, particularly patients' weakness, pain, depression and anxiety, and relatives' fatigue, anxiety or depression.Examination of selected demographic and illness factors indicated that few patients living alone or with unfit relatives stayed at home; breast cancer led to more deaths as an inpatient, whereas stomac...
177 citations