Archives of family medicine
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This article identifies the importance of delirium in general medical practice. Recent revisions in the diagnostic criteria for delirium are discussed, and the epidemiology of delirium is summarized, including the incidence and prevalence, risk factors, origins, course, and outcomes. Studies of the pathophysiological features of delirium are reviewed and recommendations are made for treatment of patients with delirium and future research.
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Optimal communication between primary care physicians and consultants includes transfer of relevant clinical information, including the patient's perspectives and values, and provides a means of collaboration to provide meaningful and health-promoting interventions. Communication difficulties arise because of lack of time, lack of clarity about the reason for referral, patient self-referral, and unclear follow-up plans. ⋯ Poor communication leads to disruptions in continuity of care, delayed diagnoses, unnecessary testing, and iatrogenic complications. Changes in the health care system offer the opportunity for improved collaboration between physicians by creating smaller administrative units within large health care systems that facilitate contact between primary care physicians and consultants; incorporation of discussions of uncertainty, patient preferences, and values into referral letters; adoption of a friendlier consultant letter format; and the improvement of the transfer of clinical data.
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Case Reports
The use of children's drawings in the evaluation and treatment of child sexual, emotional, and physical abuse.
Primary care physicians can be instrumental in the initial identification of potential sexual, emotional, and physical abuse of children. We reviewed the use of children's artwork as a method of communicating individual and family functioning. ⋯ This scoring system was based on research with 842 children (341 positively identified as sexually molested, 252 positively not sexually molested but having emotional or behavioral problems, and 249 "normal" public school children). This system is more comprehensive than previous systems of assessment of potential abuse.