Referral

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

Empirical evidence of underutilization of referrals for epilepsy surgery evaluation.

Abstract: Background: Epilepsy surgery is a treatment that can cure patients with intractable epilepsy. This study investigates whether referrals for epilepsy surgery evaluation are underutilized. Methods: Patients with epilepsy aged 18-60 years were identified in a computerized registry held by public health care providers in a Swedish county using ICD codes. Clinical data and data on referral status for epilepsy surgery were obtained from the patients' medical records. Potential candidates for epilepsy surgery evaluation were identified using pre-specified criteria. Obstacles for referral were analysed by comparing clinical data in patients who were considered for referral and those who were not. Appropriateness of non-referral was evaluated against recommendations from the Swedish Council on Technology in Health Care (SBU). Results: Of 378 patients with epilepsy in the registry, 251 agreed to participate. Of 251, 40 were already referred patients and 48 patients were identified as potential candidates for epilepsy surgery evaluation by study criteria. Referral had been considered but not performed in 15 of the potential candidates. Potential candidates not considered for referral were less likely to have seen a neurologist, to have had an EEG, CT and MRI, and more likely to have cognitive disturbances. Following the recommendations by the SBU, 28 of 48 potential candidates were identified as inappropriately not referred patients. Conclusion: The number of missed referrals for epilepsy surgery evaluation was estimated to be 60 per 100 000 inhabitants. Several important obstacles were found for not referring patients for epilepsy surgery evaluation.

Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up

Abstract: Objective: To investigate the clinical manifestations of autoimmune thyroiditis (AIT) leading to referral in children and adolescents, in addition to disease course and long-term outcome Design: Chart review Setting: Major tertiary hospital Patients: 114 children/adolescents (92 female, 22 male; mean (SD) age 118 (35) years) with AIT referred for evaluation/treatment Main outcome measures: Clinical characteristics at presentation, reasons for referral, treatment and long-term (mean 6 years) outcome; by thyroid and pubertal status Results: The male/female (1:42) ratio was lower than in adult AIT (1:10) and varied by age Patients with noticeable goitre at presentation (395%) accounted for half the total number in whom goitre was eventually diagnosed Other reasons for referral were clinical symptoms of hypothyroidism (289%) and findings on work-up for an unrelated problem (192%) or for high-risk groups (105%) There was no difference in management or outcome between patients who underwent ultrasound (n = 79) or not Treatment was initiated shortly after diagnosis in all 42 hypothyroid patients and 44/48 compensated hypothyroid patients, and within 16 months in 19/24 euthyroid patients There was no change in thyroid status in the nine untreated patients Height standard deviation score (SDS) was normal at referral and last visit and correlated with parental height SDS Puberty was normal There was no significant difference in body mass index SDS at referral by pubertal or thyroid status There was no difference from the general population in the prevalence of obesity Conclusions: Although goitre is the main symptom leading to diagnosis of AIT, it is still often overlooked, underscoring the need for thorough thyroid evaluation on routine physical examination Acquired hypothyroidism is not often associated with obesity, and ultrasound usually has no added diagnostic value Adequate treatment in this age group leads to normal growth, puberty and final height

Performance of screening tests for child physical abuse in accident and emergency departments.

Abstract: OBJECTIVES: To determine the clinical effectiveness of screening tests for physical abuse in children attending accident and emergency (A&E) departments in the UK. DATA SOURCES: Searches were limited to studies published after 1974 and were carried out from August 2004 to October 2006 using the following methods: searching electronic databases, searching the publications catalogue of the NSPCC, scanning reference lists, hand-searching journals, searching the internet, approaching professional contacts for unpublished data, and searching in three key journals. REVIEW METHODS: A simple decision-analytic model was used to integrate the findings of nine systematic reviews regarding the incidence of physical abuse, the characteristics of children attending A&E, and the performance of screening tests for physical abuse. RESULTS: A total of 66 studies, including 11 unpublished studies, were included in the nine systematic reviews. Overall the quality was poor. There was consistent evidence that physical abuse affects about 1 in 11 children in the UK each year. The proportion of abused children requiring medical attention is small but poorly quantified. Approximately 1% of all attendances of injured children at A&E are for physical abuse. There was clear evidence that physically abused children attending A&E are missed, but the performance of the clinical screening assessment was poorly quantified. There was no evidence that any test was highly predictive of physical abuse. Among severely injured children admitted to hospital, those under 1 year were more likely to be abused than older children. However, evidence that young age was a risk factor for abuse among all injured children attending A&E was inconsistent. There was weak evidence that a community liaison nurse improved the performance of the screening assessment in A&E, and it was estimated that combining a nurse with the standard screen would result in referral to social services of about half of the abused children attending A&E. However, given the poor quality of the data, this is highly uncertain. The addition of screening protocols to the clinical screening assessment offered marginal benefits, and additional false-positive referrals exceeded additional abused children detected. The benefits of protocols declined as the accuracy of the clinical screening assessment improved. The most effective protocol was to refer all injured infants and children who were social work active. CONCLUSIONS: Improving clinical screening assessment is likely to be more useful than protocols in improving the detection of physically abused children attending A&E. Further improvements might be achieved by following up children referred to paediatricians for suspected abuse who fail to reach the high level of certainty required to justify referral to social services. Many professionals voiced a need for access to experienced social services advice that is not under pressure to minimise referrals to an overloaded service, and consideration might be given to making such advice centrally available. Language: en