Common Reason For Referral Research Articles

Service evaluation of an advanced clinical practitioner (ACP) led one-stop combined cardiology and echocardiography outpatient clinic

Abstract Introduction Traditional models of hospital-based outpatient care are inefficient, unsustainable and fail to meet patient’s needs and preferences (RCP 2018). We developed a novel one-stop clinic including echocardiography delivered by a British Society of Echocardiography (BSE) accredited ACP at a district general hospital in the west Midlands, UK. No clinics of this type were identified in the literature, although there are studies demonstrating the efficacy of physiologist led valve clinics (Wasing et al., 2009) and cardiologist led ‘one stop’ clinics (Falces et al., 2008). Purpose To evaluate the outcomes for the first 12 months of the ‘scan and treat’ clinic. Methods Patient demographics, reason for referral and clinic actions were collected prospectively between July 2022 and June 2023. A retrospective electronic chart review of outcomes was completed on 1/2/2024. An un-blinded cardiologist also reviewed the records and echo images of all deaths and a further 20 randomly selected cases in February 2024. Results 143 patients were seen over 22 clinics. The most common reason for referral was suspected heart failure (34%) (table 1). Heart Failure (HFrEF, HFmrEF, HFpEF) was also the most common primary diagnosis (31%) although almost half (47%) had other reasons for referral. The reviewing Cardiologist reported appropriate diagnosis and treatment plans in the reviewed cases including all 7 deaths (5%) (3 heart failure related, 4 non-cardiac). Outcomes (figure 1) included 29 procedures: 10 DC cardioversions, 1 PCI (following the planned angiogram), 9 pacemakers (including 4 CRT devices), 3 TAVI and 6 Ablation procedures. There were 11 hospital admissions for potential cardiac causes; 1 decompensated HFrEF that may have been prevented with earlier follow up, 2 syncope cases (1 HFrEF with hypotension, 1 potential dysrrhythmia). The remaining 8 were chest pain discharged without intervention. The 17 patients (12%) with treatment changes at consultant follow up included: 1 pacemaker for asymptomatic 2nd degree AV block, 1 angiogram to investigate HFrEF and 1 sleep study for HFpEF. A further 7 had medication side effects, 4 following test results and 3 with new symptoms. 1 diagnosis of angina was overturned following a normal coronary angiogram. Conclusion This service evaluation suggests the ‘scan and treat’ clinic is a viable alternative to a traditional general cardiology clinic when an echocardiogram is also requested at triage. This has reduced total hospital visits for selected patients, streamlined care and provided additional clinic capacity with no signal of adverse outcomes. This kind of initiative may help reduce face to face appointments in line with the ‘getting it right fist time’ (GIRFT) recommendations (NHS, 2021). This review has a number of limitations including a single centre and clinician design. Further research is required to assess the safety and efficacy of this and similar non-cardiologist led ‘one-stop’ clinic designs. Table 1 Figure 1

Perceptions and Utilization of Registered Dietitian Nutritionists in Multiple Sclerosis Care: A Pilot Survey of Multidisciplinary Providers

Background/Objectives: Registered dietitian nutritionists (RDNs) are allied healthcare professionals who can help people with multiple sclerosis (MS) incorporate healthy eating, but little is known about their involvement in MS care. Thus, the objective of this survey was to investigate the perceptions and utilization of RDNs in MS care among multidisciplinary MS providers in the United States and Canada. Methods: An online survey was disseminated via the Consortium of MS Centers email listserv and MS-specific scientific conferences. The survey queried practitioner type, RDN referrals, the perceived benefits of RDNs in MS care, and the proportion of their patients who follow ‘MS diets’ or have nutrition-related issues. Reasons for or against RDN referral and beneficial resources were also queried. Results: Of the 60 completed surveys, respondents were primarily neurologists (n = 27, 45.0%). Most (n = 43, 71.7%) indicated that half or more of their patients inquire about diet, but n = 32 (53.3%) indicated that very few follow an ‘MS diet’ and n = 47 (78.3%) indicated that very few decline disease-modifying therapies to follow an ‘MS diet’. Most (n = 45, 77.6%) respondents indicated referring their patients to a RDN with lack of nutrition knowledge/general healthy eating advice (n = 34, 73.9%) and overweight/obesity (n = 31, 67.4%) as being the most common reasons for referral. RDNs were reported as being helpful or extremely helpful by n = 38 (84.4%) of respondents who reported referring to RDNs. Most (n = 46, 79.3%) indicated that their patients would benefit from having an RDN with MS-specialized training as a member of staff. Conclusions: MS care providers support the need for RDNs with specialized training in MS care.

Qualitative assessment of primary care providers' attitudes toward genetic services and genetics education.

As the role of primary care providers (PCPs) in genetic medicine increases, there is a need for training related to the integration of genetics into primary care. However, little is known about PCPs' attitudes towards and perceived needs for such training. We conducted semi-structured interviews with nine PCPs to capture information about their perceptions of their role in genetics and their continuing medical educational needs related to genetics in primary care, and we conducted thematic analysis. The identified themes fell into the following topics: perceptions of genetics, PCPs' roles in genetics, common reasons for referrals to genetic services, barriers to referrals to genetic services, genetic tests ordered by PCPs, and PCPs' educational needs regarding genetics. The most common perception of genetics was for the indication of personal or family history of cancer. PCPs' self-described role in genetics fell into two categories: recognition for when a referral for genetic services is warranted and education of families. Participants were divided in their opinion as to whether they should order genetic tests. PCP's education needs fell into four main categories: how and when to refer to genetic services, test interpretation, basic genetics, and co-management of genetic conditions, with a particular emphasis on cancer. While PCPs expressed an interest in further genetics education, they also questioned the applicability of genetics to their practice. The information obtained in this study can help inform the development of successful education activities and programs in genetics for PCPs.

AUDIT OF OBSTETRIC REFERRED CASES IN TERTIARY CARE HOSPITAL OF PESHAWAR

Objective: This study aimed to determine obstetric referral characteristics and their causes. Methods: This prospective observational study was conducted in the Gynae B unit, Khyber Teaching Hospital, Peshawar, Jan 1st, 2021 - Dec 31st, 2021. All obstetric cases referred to this hospital in the study period were included. Detailed clinical history, including the age, parity, period of gestation if antenatal, and place of referral, were recorded. A thorough general physical and obstetrical examination was performed, and required investigations were sent. The patient's treatment, including vaginal delivery, cesarean section, and conservative management, was recorded. Data analysis was done using SPSS 22.0. Results: Total obstetric admissions during the study period were 5,242; total referrals for obstetric indications were 1,678, constituting 32% of all obstetric admissions. 1241 (74%) of cases fall within the age group of 20-30, while 234 (14%) were under 20 years old and 201 (12%) were over 30 years. 588(35%) of patients were prim gravidas, 453(27%) were multi and 335(20%) were grand multigravidas. 56% of patients presented during antenatal, while 604 (36%) arrived intrapartum and 302 (18%) postpartum. The mode of transport used by the referred patients was an ambulance in 369(22%) and private vehicles in 1308(78%) cases. The most common reasons for obstetric referrals were hemorrhagic disorders, accounting for 28%, and hypertensive disorders, which made up 18%. Conclusion: Complex obstetric cases are referred to our tertiary care facility. A proper referral system is needed for tertiary care-level hospitals. The process of transferring patients between hospitals highlights the importance of teamwork. It is necessary to acknowledge that tertiary care is the only option for high-risk referrals.

Review of a specialist Rett syndrome clinic from 2003 to the COVID pandemic: clinic experience and carer perspectives

BackgroundWe have held a ‘trouble-shooting’ clinic for Rett syndrome patients from 2003 until the COVID pandemic in 2020. The clinic was multidisciplinary, including clinical genetics, paediatric neurology, adult learning disability psychiatry and physiotherapy. Access to specialist communication support and eye-gaze equipment was also often available. We have reviewed the files of patients seen in the clinic and conducted a survey of parents’ and carers’ satisfaction with the clinic and their experiences during COVID.ResultsOf the 117 patients seen in the clinic, records were reviewed of 103 (97 female, six male) who attended a total of 123 appointments. The records were unavailable for 14 patients. The most common reasons for referral were assessment of ‘episodes’ of uncertain nature (possibly epileptic, possibly autonomic), the wish for a general review by an experienced team, and questions about the diagnosis. We discuss the nature of the advice we were able to provide and offer some brief case vignettes. We wrote to the parents or carers of all patients seen and 63 respondents were willing to be interviewed about the clinic and their experiences during COVID. Respondents were generally complimentary about the clinic team, emphasising the value of a specialist clinic for those affected by a rare condition. Respondents gave insight into the range of problems experienced during COVID, especially the isolation resulting from the withdrawal of services, demonstrating the value of community support. Some respondents mentioned the shift to remote consultations, which they hoped would continue after COVID for its convenience. However, others talked about how difficult it is in a remote consultation to explain the problems of the affected family member to professionals who do not know the patient or know about Rett syndrome.ConclusionsOur findings demonstrate the value of a disease-specific clinic provided by staff experienced with the particular rare condition. Meeting the needs of patients with ultra-rare conditions presents additional challenges. We have also found that the shift to holding a virtual clinic during COVID brought the benefit of convenience but was unsatisfactory in other ways, as it makes clinical assessment more difficult and fails to overcome the sense of isolation during a pandemic.

Lessons from a web-based referral system for acute neurosurgical referrals. Part 2: Referral trends and outcomes

BackgroundThe adoption of electronic referral systems has transformed healthcare delivery, particularly in neurosurgery, where timely referrals are crucial. Despite increasing interest, limited research exists on the demographic characteristics and referral patterns in neurosurgery. This study aims to fill this gap by analysing data from the Hospital Emergency Neurosurgical Referral Interface (HENRI) at the Royal Brisbane and Women’s Hospital (RBWH). MethodsA retrospective analysis of 3,791 referrals to the RBWH Neurosurgical Department via HENRI between February 2021 and February 2022 was conducted. Patient characteristics, provisional diagnoses, urgency classifications, decisions, procedures, and anti-thrombotic use were analysed. ResultsThe majority of referrals (40%) came from within the Metro North Catchment, with trauma being the most common reason for referral (30%). Notably, a significant proportion of referrals did not necessitate neurosurgical intervention (33%). Urgency classifications often did not align with the need for transfer or surgical intervention, indicating potential overestimation of urgency. Patients transferred to RBWH were younger, with a higher proportion undergoing procedures. Antiplatelet and anticoagulant use was common, particularly in older patients with iatrogenic coagulation abnormalities. ConclusionsOur findings highlight the need for accurate diagnosis and appropriate triaging of patients to optimize resource allocation and patient care. Improved communication between referring teams and neurosurgical services is crucial to streamline the referral process. Furthermore, addressing challenges in managing neurotrauma at peripheral sites is essential to ensure timely access to appropriate care. Future research should focus on implementing interventions to improve efficiency and effectiveness in neurosurgical referrals.

Congenital heart diseases detected by fetal echocardiography and the prevalence: A single center experience

Aim: Fetal echocardiography is an effective screening tool for the detection of cardiac anomalies. The aim of this study is to evaluate risk groups of pregnant women, to determine congenital heart diseases in each group and to find the prevalence of cardiac anomalies in our region. Materials and Methods: All pregnant women referred for fetal echocardiography from January 2023 and September 2024 were included in the study. Results: A total of 387 pregnant women underwent fetal echocardiography of which 136 were low risk group and 251 were high risk group. The mean ages of patients were 27.43±1.37 and 28.54±5.45 years, respectively. Maternal diabetes (13.17%), dysrhythmia (5.42%) and history of previous child or fetus with extracardiac anomaly (8.53%) were the most common reasons for referral in the high-risk group. While ventricular septal defect was the most detected congenital heart disease in low risk group; hypoplastic left heart syndrome (1.20%) and pulmonary atresia/hypoplasia (1.20%) were the most detected cardiac anomalies in high risk group. The prevalence of congenital heart diseases in our series was found to be 2.94% and 6.37% in the low-risk and high-risk pregnancies respectively while the overall prevalence was 5.16%. Conclusion: Fetal echocardiography is a very useful technique when performed by experienced individuals with sufficient time. Dedicated cardiac screening should be part of the routine anomaly scan. Also, detailed fetal echocardiography should be performed in all pregnant women who were in low or high risk groups.

Referral pattern of pregnant mother for fetal echocardiography in Shiraz, South Iran

ObjectiveTo evaluate the referral patterns for fetal echocardiography at a tertiary care center in Shiraz, South Iran.MethodThis retrospective cohort study analyzed data from 22,600 pregnant women who underwent fetal echocardiography between January 1, 2016, and December 31, 2021. Information was extracted from a centralized electronic medical record system used by medical centers affiliated with Shiraz University of Medical Sciences.ResultCongenital heart disease was detected in 14.5% of fetal echocardiograms. The mean gestational age at the time of examination was 21.8 ± 4.2 weeks (range: 13–40 weeks). Notably, 75.9% of pregnant women were referred after 19 weeks of gestation. The most common reason for referral was abnormal fetal laboratory screening (triple or quad test).ConclusionIn our center, fetal echocardiography is optimally performed by 19 weeks of gestation. This timing allows for detailed anatomical assessment and aligns with the legal threshold for abortion, ensuring timely counseling and decision-making when necessary. However, in our study, the mean gestational age at the time of echocardiography was 21 weeks, indicating that a significant proportion of patients underwent the procedure later than the optimal timing.

Equal, equitable or exacerbating inequalities: patterns and predictors of social prescribing referrals in 160 128 UK patients.

Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear. To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions. This study undertook the first analyses of a large database of administrative data from over 160 000 individuals referred to social prescribing across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables. Mental health was the most common referral reason and mental health interventions were the most common interventions prescribed. Between 72% and 85% of social prescribing referrals were from medical routes (primary or secondary healthcare). Although these referrals demonstrated equality in reaching across sociodemographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical routes (e.g. self-referral, school, charity). Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities - especially ones relevant to mental health, practical support and social relationships - was evident. There was also substantial heterogeneity in how social prescribing is implemented across UK nations. Mental health is the leading reason for social prescribing referrals, demonstrating its relevance to psychiatrists. But there are inequalities in referrals. Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing and therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.

A New Combined Urogynecology and Colorectal Surgery Pelvic Floor Clinic-1 Year On.

This study is aimed at characterizing patients seen at a new combined pelvic floor clinic (CPFC) established at a tertiary women's hospital in Singapore. Study goals include identifying patterns of symptom clusters and reviewing management strategies compared with international care standards, improving understanding of complex female pelvic floor dysfunction, and guiding future development of clinical and ancillary support. This is a single-center, retrospective cohort study of medical case record review for all patients seen at the CPFC between 1 September 2020 and 31 August 2021. All patients seen at CPFC during this study period were included for analysis. Data were deidentified and aggregated, with analysis performed for descriptive and summary statistics. Institutional Review Board approval was obtained with waiver of informed consent. Sixty-six referrals were made to the CPFC, with 57 patients seen in 11 clinic sessions across the 12-month period. The most common reasons for referral were fecal or flatus incontinence (30, 52.6%), severe constipation or defecatory dysfunction (21.1%), and rectal prolapse (17.5%). Most patients (78.9%) had multiple symptoms. Our patient demographic profile aligns with known risk factors for pelvic floor dysfunction, presenting with gastrointestinal symptoms-similar to PFCs worldwide. The new workflow and services were well positioned to address patients' needs, including those left previously untreated, or received uncoordinated care. Conservative approaches were first employed, like with other global PFCs. The combined multidisciplinary model of care resulted in good outcomes for patients managed both conservatively and surgically. Future studies to analyze patient satisfaction are planned.

Integrated palliative care visits of patients with incurable cancer in Tampere University Hospital 2018-2021-a retrospective study.

Integration of palliative care has been shown to be beneficial and is therefore recommended. However, the specific methods for arranging such care remain unclear. Systematic referral and regular visits with a multi-professional palliative care team have appeared most beneficial. This study aimed to study how integrated palliative care is currently carried out in relation to which patients are referred to an integrated visit and what occurs during the visit, along with lifespan after the first integrated visit. A retrospective chart review of all patients with an incurable cancer receiving integrated palliative care with ongoing oncologic therapy, who were treated in Tampere University Hospital, Finland, between January 1, 2018 and June 30, 2021. Altogether 207 patients were referred to an integrated palliative care visit, which covers 4% of the incurable cancer patients in the department of oncology at the same time. The most common reasons for referral were symptom burden and limited anti-cancer treatment possibilities. The need for advance care planning was seldom identified. During the first year after the integrated visit, 99 (48%) patients died. Approximately one-third of the patients received anti-cancer treatment in the last month of their life. Based on the results of the study, the need for palliative care might be unmet, since so few patients are referred to integrated palliative care visits. Emphasis should be placed on identification of palliative care needs and advance care planning. The follow-up models of outpatient clinics should be examined and developed to better meet the needs of the patients.

Exploring the diagnostic yield of family screening and genetic testing in adolescent individuals with pre-clinical phenotypes

Abstract Introduction Family screening and genetic testing are key components in the management strategy of individuals diagnosed with an inherited cardiac condition (ICC). Disease penetrance for most ICCs, notably cardiomyopathies is age dependent, which is why a more permissive approach towards family screening is adopted in young individuals with a pre-clinical phenotype. Study Objectives The main objective of this study was to explore the role of family screening and genetic testing in adolescent subjects with a pre-clinical phenotype has not been formally explored. Methodology Adolescent probands with a pre-clinical phenotype following a national cardiac screening program (BEAT-IT) were offered genetic testing and family screening. Probands with anterior TWI were rescreened at 16 years. Only those with persistent changes were enrolled in the study. Genetic counselling was also offered to probands and relatives. Testing was initially offered to first degree relatives. Cascade testing (clinical and genetic) was also offered to other generations if a screened relative satisfied one or more of these conditions i) phenotype positive, ii) pre-clinical phenotype, iii) clinically relevant genotype. Results 16 probands (mean age 15 years) were identified with a pre-clinical phenotype. All had an abnormal ECG (9=inferior/lateral TWI, 6=anterior TWI, 1=ST depression). A comprehensive evaluation was otherwise normal. Half were gene positive (G+), 4 had clinically relevant genotypes (n=4 inferior/lateral TWI). These were classified as likely pathogenic according to ACMG criteria (n=2 MYH7, n=1 ACTC1, n=1 MYBPC3). 71 family members were subsequently screened (59.2% female, median 43Y [IQR 27] at evaluation, 11.3% <18Y at evaluation, 67.6% first degree relatives). A substantial proportion (n=13, 18.3%) were referred for further evaluation. Two (2/8, 25.0%) were <18Y. An abnormal ECG was the commonest reason for referral (n=9, 12.7%). Three (4.2%) were given a diagnosis (n=2 HCM [both MYH7}, n=1 DCM [ACTC1]). Seven (9.9%) were referred because of an abnormal ECG (n=3 inferolateral TWI, n=2 ventricular ectopics, n=1 anterolateral TWI, n=1 ST depression). Four were G+ and were offered surveillance. Fourteen (19.7%) were offered family screening because of incorporating genetic testing into the study protocol. Genetics altered the evaluation strategy in 16.9% of screened relatives. More in-depth cascade testing identified 6 (8.5%) individuals who needed follow-up (n=1 diagnosis [DCM], n=1 abnormal ECG, n=4 G+). Gene negative individuals (6, 8.5%) were safely reassured and discharged. Conclusion Family screening in adolescent probands with pre-clinical phenotypes offers a reasonable diagnostic yield (4.2% diagnosis, 14.1% surveillance). Incorporating genetic testing into the evaluation protocol offers a more personalized strategy, altering management in a significant proportion of screened relatives (16.9%).

Cytogenetic-Phenotypic Profile of Filipinos with Myelodysplastic Syndrome in Makati Medical Center: A 10-Year Review

Hematologic malignancies remained to be a significant contributor in the Global Burden of Disease. Myelodysplastic syndrome is one of the hematologic malignancies and has remained to be underestimated, underreported, and underdiagnosed. It is a group of hematologic malignancies that proves a challenge in diagnosis and is characterized by clonal hematopoiesis, with one or more cytopenias. Data on Prevalence of Myelodysplastic syndrome globally is scarce, moreso, not available in the Philippines. This is the first clinical profile study in Myelodysplastic Syndrome in the Philippines. This 10-year study has shown that 240 patients were diagnosed to have Myelodysplastic syndrome but only 35 had the MDS Fluorescent-in-Situ Hybridization test done. The most common reasons for hematologic referral, chief complaint, signs, cytogenetic test are anemia, low hemoglobin, pallor and fatigue, del7q31 which belongs to the Good risk cytogenetic category respectively. The most common CBC findings were hemoglobin of 8 and above, ANC of above 800 and Platelets of 50 and higher. There was no noted significant difference in the clinical profile of patients with MDS based on FISH study results

Medical Tourism for Cancer Treatment: Trends, Trajectories, and Perspectives From African Countries.

Cancer continues to be a significant public health concern. Sub-Saharan Africa (SSA) struggles with a lack of proper infrastructure and adequate cancer care workforce. This has led to some countries relying on referrals of cancer care to countries with higher income levels. In some instances, patients refer themselves. Some countries have made it their goal to attract patients from other countries, a term that has been referred to as medical tourism. In this article, we explore the current status of oncology-related medical tourism in SSA. This was a cross-sectional study. The study participants included oncologists, surgeons, and any other physicians who take care of patients with cancer. A predesigned questionnaire was distributed through African Organization for Research and Training in Cancer member mailing list and through study team personal contacts and social media. A total of 52 participants from 17 African countries with a 1.6:2 male to female ratio responded to the survey. Most (55.8%) of the respondents were from Eastern African countries. The majority (92%) of study participants reported that they knew patients who referred themselves abroad, whereas 75% referred patients abroad, and the most common (94%) referral destination was India. The most common (93%) reason for referral was perception of a higher quality of care in foreign health institutions. The findings suggest the need to improve local health care systems including building trust of the system among general population. The study highlights potential financial toxicity, and it adds to the current emphasis on return of investment on homegrown workforce and cancer treatment infrastructure.

Teiripe sa Bhaile: ICPOP Early Supported Discharge for Frailty

Abstract Background Older adults and particularly older adults with frailty are high users of acute hospital care which results in overall higher hospital costs and reduced functional independence. Early supported discharge (ESD) was found to have a statistically significant impact in reducing length of stay in older adults admitted for medical reasons. This poster outlines the rehabilitation pathway developed by an ICPOP team to provide early supported discharge for frail older inpatients with SMART rehab goals. Methods Suitable patients are identified and assessed prior to discharge from the acute ward. Each patient receives a comprehensive geriatric assessment in their own home. All patients receive at least 2 hours of therapy per week until they have reached their goals. Standardised outcome measures including Functional Assessment Measure (FIM/FAM) and EQ5D5L are captured for each patient. Clients are discharged once they have reached their goals or are at their new functional baseline. Results 52 patients have been seen on this pathway since 2023. Hip fracture was the most common reason for referral, followed by Falls. Average length of stay on service was 40 days. Average wait time to first assessment was 1.7 days, highlighting the responsiveness of the service. 4 patients seen in 2024 live alone, indicating this service is also appropriate for patients who don’t have supports readily available in the home. FIM/FAM scores increased from 148 to 160 on average- Indicating more functional independence. Conclusion This ICPOP Rehabilitation pathway offers a safe, person-centred alternative to traditional inpatient rehabilitation. Readmission rates post discharge were low indicating the programme's safety. Given the large number of hospital bed saved without compromising functional outcomes for the patients, the ICPOP team is working on expanding this pathway.

Ophthalmology inpatient consultations: an Irish tertiary hospital experience.

Ophthalmology consultation on inpatients is often important to optimise eye care and provide information for referring teams. Inpatient consultation may constitute a not-insignificant workload however. This study reports on the nature and necessity of ophthalmology inpatient consults in a large Irish hospital. Retrospective analysis of all consecutive ophthalmology inpatient consultations over a 12-month period. In total, 359 consult requests were received primarily from adult medicine (57.9%), surgery (22%) and paediatric teams (18.4%). The most common reasons for referral were loss of vision (23.7%); visual field testing (15%); diplopia or abnormal eye movements (11.4%); and screening for ocular features of systemic disease (10.6%). Presumptive diagnoses by referring teams were correct in 29.5% of cases. The majority had normal eye examinations (53.2%) or non-sight-threatening features (16.8%), while a minority had acute eye pathology (30%). Most patients (80.4%) required no intervention. A minority required medical (12.5%), orthoptic (4.6%) or surgical (2.4%) intervention. The majority of patients (81%) were fit for transfer to the eye clinic and did not require bedside examination. Our study found a high proportion of ophthalmology inpatient consultations had normal eye exams and required no intervention. The quality of referrals was variable suggesting that clearer guidelines and more ophthalmology education is needed for referring teams.

Enhancing Telemedicine Communication for Improved Outpatient Pediatric Trauma Care.

Pediatric traumatology is a complex field that requires a comprehensive understanding of physeal development, remodeling potential, and the ossification process in order to ensure appropriate patient treatment. The objective of this study was to assess the willingness of practicing physicians to participate in a telemedicine collaboration aimed at enhancing the exchange between the outpatient and inpatient sectors and promoting the digitalization of the pediatric sector. This is in response to the growing significance of digitalization in the medical field. A survey consisting of 15 items was sent to 800 practicing trauma surgeons, pediatric surgeons, and pediatricians within a 100 km radius of Hamburg, Germany. The survey included questions about the respondents' professional experience and telemedicine experience, as well as inquiries about possible telemedicine collaborations. The response rate was 19.3%. Less than half of the participants already used telemedicine in daily practice. In general, 75% of respondents expressed an interest in collaborating with the inpatient sector. The most common reasons for hospital referral were the need for surgery, inadequate treatment of children in practice and co-assessment. The majority were in favor of flexible communication, either via video telephony, imaging applications like or messaging applications. The study revealed a high level of interest in telemedicine collaboration. Information exchange should be tailored to individual needs, with practitioners requiring a versatile and personalized approach that includes imaging. Strict enforcement of data protection regulations is essential. Further research is needed to evaluate the effectiveness of telemedicine collaboration in the treatment of pediatric trauma in both hospital and outpatient settings.

Evaluation of the Veterans Health Administration's Digital Divide Consult for Tablet Distribution and Telehealth Adoption: Cohort Study.

Video telehealth offers a mechanism to help Veterans Health Administration (VHA) patients overcome health care access barriers; however, many veterans lack a suitable device and sufficient internet connectivity. To address disparities in technology access, VHA established a Connected Device Program that offers veterans loaned video-capable tablets and internet service. In 2020, VHA introduced a national Digital Divide Consult to facilitate and standardize referrals for this resource. We sought to evaluate the reach and impact of VHA's Connected Device Program, leveraging Digital Divide Consult data to determine whether resources are supporting veterans with health care needs and access barriers. We examined the reach of VHA's Connected Device Program using national secondary data from VHA's electronic health records among 119,926 tablet recipients who received a tablet (April 1, 2020, to February 28, 2023) and 683,219 veterans from the general VHA population. We assessed changes in tablet recipients' demographic and clinical characteristics before and after implementation of the Digital Divide Consult compared with the general VHA population. We examined the impact of tablets and the consult on adoption of telehealth (ie, video visit use and number of visits) adjusting for differences between tablet recipients and the general VHA population. Finally, we evaluated consult implementation by assessing the use of video-based services by tablet referral reason. Common reasons for tablet referral included mental health diagnoses (50,367/79,230, 63.9%), distance from a VHA facility >30 miles (17,228/79,230, 21.7%), and social isolation (16,161/79,230, 20.4%). Moreover, 63.0% (49,925/79,230) of individuals who received a tablet after implementation of the Digital Divide Consult had a video visit in the first 6 months of tablet receipt. Some consult reasons were associated with a higher-than-average percentage of video telehealth use, including enrollment in evidence-based mental health programs (74.8% [830/1100] with video use), living >30 miles from a VHA facility (68.3% [10,557/17,228] with video use), and having a mental health diagnosis (68.1% [34,301/50,367] with video use). Tablet recipients had nearly 3 times the likelihood of having a video visit within a month once provided a tablet compared to the general VHA population, with an adjusted risk ratio of 2.95 (95% CI 2.91-2.99) before consult implementation and 2.73 (95% CI 2.70-2.76) after consult implementation. Analyses of telehealth adoption suggested that veterans receiving tablets for mental health care and evidence-based programs have higher rates of video visits, while those who are homebound or receiving tablets for hospice have higher rates of nonuse. This evaluation of VHA's Connected Device Program suggests that tablets are facilitating video-based care among veterans with complex needs. Standardization of referrals through the Digital Divide Consult has created opportunities to identify groups of tablet recipients with lower telehealth adoption rates who might benefit from a targeted intervention.

Unveiling referral's impact on asphyxiated newborns: a cross-sectional study

Background: Birth asphyxia also known as perinatal asphyxia, refers to the lack of oxygen during the childbirth. The asphyxiated newborns require a comprehensive care and many special newborns care units have established in Gujarat for the sick newborns. This study mainly focuses on understanding the reasons for referral, the average travel time to tertiary care institutions, and identifying gaps to minimize unnecessary referrals among patients. Methods: The cross-sectional study was conducted over a period of one year, and out-born asphyxiated newborns were selected based on the inclusion criteria. A pretested, semi-structured questionnaire was used to collect the data, which was later analyzed using Microsoft excel and statistical package for the social sciences (SPSS) 26. Results: Out of the 131 newborns, 31% had moderate-severe asphyxia. Approximately 9% of the patients had to travel for more than 2hours to reach the final health facility. Among the patients, risk of mortality was significantly higher among the those who were referred from the private health facility. Lack of availability of bed, ventilator and economic burden were among the common reason for referral. Conclusions: There is a necessity to prevent unnecessary multiple and delayed referrals, and to provide essential care during transport to improve the outcomes.

TRANSITION TO THE SPECIAL NEEDS REPORT FOR CHILDREN (SNRC): AN ANALYSIS OF REFERRALS TO CHILD AND ADOLESCENT PSYCHIATRY OVER THE LAST THREE YEARS

Objective: Following the enactment of the Special Needs Report for Children (SNRC) regulation on February 20, 2019, several changes were made to the reporting system. The field of child psychiatry is among the leading specialties issuing SNRC reports. This study aimed to evaluate the psychiatric and other medical diagnoses of cases referred to pediatric and adolescent psychiatry for SNRC, determine their level of needs, and discuss the new regulation in the context of existing literature. Material and Methods: Demographic and clinical characteristics, as well as levels of needs and relevant areas, were retrospectively analyzed for cases aged 0-18 who presented to a university hospital's pediatric and adolescent psychiatry clinic between January 2021 and January 2024. Results: A total of 986 children and adolescents, comprising 331 (33.6%) females and 655 (66.4%) males, with a mean age of 10.27±3.77 years, were included in the study. The most common reason for SNRC referral in the 0-4 age group was speech delay (n=32, 45.1%) while learning difficulties were predominant in other age groups. Analysis of psychiatric diagnoses under SNRC revealed delayed milestone diagnosis as the most common at 45.7% (n=451), followed by specific learning disorder (n=312, 31.6%) and autism spectrum disorder (n=154, 15.6%). Non-psychiatric diagnoses showed that 28.8% (n=284) of cases had at least one accompanying medical disease, including cerebral palsy (n=65, 6.5%), sensorineural hearing loss (n=47, 4.8%), epilepsy (n=37, 3.8%), and Down syndrome (n=21, 2.1%). Additionally, 20% (n=198) of cases exhibited special needs in at least one non-psychiatric area, with motor development being the most common domain (n=125, 63.1%). Conclusion: These findings highlight the diversity of needs among children and adolescents receiving SNRC reports. Accurate evaluation and reporting of special needs in child and adolescent psychiatry are crucial for enhancing individuals' quality of life and providing necessary support.