Reason For Referral Research Articles

Evaluation of a psychiatric pharmacist consultation service in a multispecialty outpatient clinic

AbstractBackgroundIntegrated care programs provide both medical and mental health care in clinical settings. Psychiatric pharmacists play a key role in optimizing patient care when integrated into a healthcare team. This project describes the implementation and trends of a psychiatric pharmacist consultation service in a multispecialty outpatient through an integrated behavioral healthcare model.MethodsThis is a retrospective study analyzing a psychiatric pharmacist consultation service at an academic multispecialty outpatient clinic. Eligible patients were aged ≥17 years and seen by the psychiatric pharmacist between June 1, 2019 and June 30, 2022. Patient demographics, reasons for referral, and pharmacist interventions were collected. Patient outcomes on depression, anxiety, and diabetes were also explored. Descriptive statistics were used to quantify information.ResultsA total of 572 encounters were identified. Of those, 285 (49.8%) represented unique patients. Over the 36‐month period, an average of 16 consults were conducted per month. Anxiety and depressive disorders, pain syndromes, and adult attention‐deficit/hyperactivity disorder were the most common diagnoses listed as reasons for consultation. An average of five recommendations or interventions were provided by the psychiatric pharmacist at each initial consultation. Anxiety and depression symptom scores, as well as hemoglobin A1c (HbA1c) values, were lower following pharmacist consultation.ConclusionPsychiatric pharmacists can serve a unique role at multispecialty clinics by providing consultation for patients with psychiatric conditions, chronic pain, medical conditions, and polypharmacy. This study demonstrates the successful utilization of such a service and suggests a psychiatric pharmacist's expertise contributes to improved depression, anxiety, and glycemic outcomes. The multispecialty outpatient setting represents an opportunity to further explore growth for psychiatric pharmacists and the impact these services have on patient outcomes.

Impact of an Evidence-Based Prioritization System and Electronic Consultation in Early Diagnosis of Colorectal Cancer.

(1) Background: Colorectal cancer (CRC) is one of the most common causes of cancer. Timely diagnosis is critical, with even minor delays impacting prognosis. Primary care providers face obstacles in accessing specialist care. This study investigates the impact of implementing an electronic consultation (eConsult) system combined with a specific prioritization system on CRC diagnosis delay and tumor staging. (2) Methods: The study analyzes 245 CRC patients from November 2019 to February 2022, comparing those referred before and after the eConsult system's implementation during the COVID-19 pandemic. Data on referral reasons, pathways, diagnosis delays, and staging were collected. Multivariate analysis aimed to identify independent risk factors for advanced staging at diagnosis. (3) Results: The eConsult system significantly reduced CRC diagnosis delay from 68 to 26 days. The majority of patients referred via eConsult presented with symptoms. Despite expedited diagnoses, no discernible difference in CRC staging emerged between eConsult and traditional referrals. Notably, patients from screening programs or with a positive fecal immunochemical test (FIT) experienced earlier-stage diagnoses. A positive FIT without symptoms and being a never-smoker emerged as protective factors against advanced-stage CRC. (4) Conclusions: This study highlights eConsult's role in reducing CRC diagnosis delay, improving diagnostic efficiency and prioritizing urgent cases, emphasizing FIT effectiveness.

Characterization of patients with brain metastases referred to palliative care

PurposeIn this study, we aimed to assess the clinical characteristics, reasons for referral, and outcomes of patients with brain metastases (BM) referred to the supportive care center.MethodsEqual numbers of patients with melanoma, breast cancer, and lung cancer with (N = 90) and without (N = 90) BM were retrospectively identified from the supportive care database for study. Descriptive statistics were used to analyze demographic, disease, and clinical data. Kaplan Meier method was used to evaluate survival outcomes.ResultsWhile physical symptom management was the most common reason for referral to supportive care for both patients with and without BM, patients with BM had significantly lower pain scores on ESAS at time of referral (p = 0.002). They had greater interaction with acute care in the last weeks of life, with higher rates of ICU admission, emergency room visits, and hospitalizations after initial supportive care (SC) visit. The median survival time from referral to Supportive Care Center (SCC) was 0.90 years (95% CI 0.73, 1.40) for the brain metastasis group and 1.29 years (95% CI 0.91, 2.29) for the group without BM.ConclusionsPatients with BM have shorter survival and greater interaction with acute care in the last weeks of life. This population also has distinct symptom burdens from patients without BM. Strategies to optimize integration of SC for patients with BM warrant ongoing study.

Assessment of dietary interventions including low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet as management for fructose intolerance.

Abdominal pain remains one of the most common referral reasons to pediatric gastroenterology. Dietary intolerances are often considered but due to various factors are hardly pursued. We observed that diet review in large number of children with abdominal pain was high in sugary foods which led to food intolerance investigation and dietary intervention. A retrospective review was conducted of patients presenting with abdominal pain, diarrhea, or vomiting and negative GI evaluation, who underwent fructose breath testing. Patients younger than 20 years old who were seen between June 1, 2018 and March 1, 2021 were included. Statistical analysis was performed in R. There were 110 pediatric patients during the study period who underwent fructose breath testing, with 31% male and 69% female. The average age was 12.14 ± 4.01 years, and the average BMI was 21.21 ± 6.12. Abdominal pain was the most common presenting symptom (74.5%) followed by diarrhea and vomiting. Seventy-seven patients (70%) had a positive fructose breath test and were diagnosed with dietary intolerance to fructose. The 56 (67.5%) of those patients experienced symptoms during the breath test. Forty-three patients improved with dietary intervention. Twenty-seven on low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols diet and 16 on other diets. Based on analysis of our cohort of children with abdominal pain and high incidence of fructose intolerance as well as improvement in symptoms, following dietary changes, this condition should be considered and treated. Further investigation is needed to improve diagnostic testing but also into understanding mechanisms behind symptom presentation in this population.

Pattern of adult psychiatric emergencies at a tertiary care center before and after the onset of the COVID-19 pandemic.

A gap exists in published data on psychiatric emergencies presenting to Indian centers over the entire pandemic. We assessed 2,048 consecutive adult psychiatric emergencies for the period April 2019-September 2021 to compare 18 months following the onset of the pandemic, with the pre pandemic year as the control. Mean age was 33.8 ± 13.6 years, with 55% females. The proportion with ICD-10 schizophrenia and related psychotic disorders (18.9% vs 15.3%; P = 0.031), mood disorders (21.8% vs 18.1%; P = 0.038), and personality disorders (3.8% vs 2%; P = 0.018) showed a significant increase during a pandemic, while those with no diagnosable illness reduced (28.6% vs 34.3%; P = 0.006). Suicidality was the reason for referral in 43%, comparable to pre pandemic year. Those with stay ≥24 hours increased (14% vs 11%; P = 0.034). Benzodiazepines remained the commonly prescribed medication, but a notable rise was seen in mood stabilizer prescriptions.

Increasing Accessibility to Intradialytic Cycling in Rural and Remote Settings: Program Report.

Access to exercise and rehabilitation is often lower in rural or remote areas and hemodialysis (HD) dependence imposes additional barriers. Intradialytic cycling (IDC) can improve HD-related symptoms, such as leg cramping, restless legs, and symptoms of depression, as well as physical function and fitness, but access to exercise professionals with this expertise is limited. To promote access to IDC in rural and remote HD units, we describe the implementation and initial evaluation of a novel IDC program using virtual assessment to safely prescribe and individualize IDC. We developed and piloted a protocol for virtual IDC assessment and prospectively collected metrics informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to support future quality improvement activities. Rural HD units were defined as per Alberta Kidney Care North (AKC-N)'s operations. The virtual IDC program components were: HD unit education sessions, support and interest from local unit staff and those receiving HD, a bike, a supervising kinesiologist, a stable Internet connection, a nurse present during the 25-minute initial virtual assessment, and virtual follow-up every 3 to 4 weeks with the kinesiologist. The initial assessment consists of a virtual bike test where the participant performs a graded, symptom-limited cycling trial with documentation of vital signs and rating of self-perceived exertion (relative intensity). The data are used to prescribe IDC (frequency, intensity, time). The HD unit staff learn participant and bike set-up, confirm safe exercise parameters for that day, adjust the bike intensity, and take vital signs. Outcomes for evaluating the impact of the IDC program using the RE-AIM health framework were selected. Out of the 24 HD units in AKC-N, 18 units were defined as either remote or rural (75%). Four of the units (22%) adopted the program, which was less than our target of 30% of units. Individual-level participation (Reach) within those units ranged widely (1-67%) with only one unit reaching the target of at least 30% individual-level participation. Reasons for starting IDC were intradialytic cramping, restless legs, deconditioning, and boredom during HD. Reasons for non-participation were lack of interest and a desire to sleep. Routine exercise program questionnaires on health-related quality of life for program effectiveness were not consistently completed by participants. All virtual assessments were completed as per protocol with a nurse (100% fidelity); however, tests often needed to be re-scheduled due to technical issues with Wi-Fi, limited unit staffing, operational demands, and/or safety concerns. At 1 year, all 4 units continued to participate with 2 additional HD units starting the following year. Reach could be improved by introducing intradialytic exercise to individuals at HD initiation, prior to moving to their local satellite HD unit. Existing measures of program effectiveness may not be relevant to program participants or feasible to implement without an on-site exercise professional. Technical issues and navigating the busy schedules of unit staff were limitations to completing tests as scheduled. Implementing a protocolized approach with virtual support can increase accessibility to an evidence-based treatment in HD units without exercise professionals. For people requiring HD, reach may be improved with early education and exposure at HD start and with orientation sessions for staff. Adding a virtual IDC assessment day for staff as part of their routine monthly task schedule may promote institutionalization. Formalized follow-up sessions for kinesiologists and nurses to discuss program concerns would benefit the program in the future. Completion of program effectiveness measures may be improved by selecting more individualized options, for example, person-reported measures related to the individual's reason for referral.

Prevalence and reasons for referrals to the Endodontics Specialty Clinic at the Piracicaba Dental School.

Dental referrals to the Endodontics Specialty Clinic (ESC) are routine owing to the complexity of endodontic treatments. To obtain a better prognosis for treatment, students/dentists must perceive their technical limits. This study sought to investigate the referrals of patients to the ESC from different clinics of the Piracicaba Dental School, State University of Campinas - SP, Brazil, and check: a) the demographic profile of patients and the most commonly affected tooth; b) the clinic with the largest number of referrals; c) the reasons for referrals; d) the complexity of the cases; e) and the difficulty in assessing the referred cases based on the classification provided by the American Association of Endodontists (AAE) and Souza-Filho. The study sample consisted of patients' electronic dental referral records from February 2015 to June 2019. A total of 1,707 patients were referred to the ESC during the study period, and 62.4% were female. Lower molars were the most frequently involved teeth (34.8%), and 60.7% of the cases were referred due to the presence of root curvature. The AAE classification showed prevalence of highly difficult cases (71.3%), whereas Souza-Filho classification demonstrated a high rate of class III cases (85.8%). This study highlights the difficulties encountered by undergraduate students before or during endodontic treatments, reinforcing the need for clear criteria for selecting cases appropriate for each education level, thus improving endodontic treatment prognosis.

The necessity and reasons for referrals to endodontists among general dentists in Mashhad: A cross-sectional study

Introduction: This study aimed to identify the necessity and reasons for patient referral to endodontists among general dentists in Mashhad, Iran, in 2021. Materials and Methods: This research employed a descriptive cross-sectional study design. Two hundred general dentists participated in the survey, answering a questionnaire with confirmed reliability and validity. The questions focused on their reasoning for deciding to perform or not perform root canal treatment, their rationale for referring or not referring patients to endodontists, and the factors influencing these decisions. Data were analyzed using the SPSS-19 software, using Chi-square and Mann–Whitney tests (α = 0.05). Results: Of the respondents, 68% performed root canal therapy routinely, while 8.5% reported never performing root treatment. Men were more likely to perform root canal therapy than women (P < 0.001). Among the dentists who performed root canal therapy, 76.5% considered endodontic referrals necessary, and the number of referrals was higher among female dentists than male dentists (P < 0.001). Overall, the main reasons for referral to endodontists include noncooperation of the patient, open apex, and mouth opening limitations. Fear of losing the patient and the high costs of specialized treatment were the reasons for nonreferral to endodontists. Conclusion: There is a need to eliminate the barriers to endodontic referral among general dentists in Mashhad. Economic issues played a substantial role in dentists’ unwillingness to perform root canal therapy and endodontic referral. The study provides insights into the reasons for referral, which can guide the development of strategies to improve endodontic care and patient outcomes.

Profile of patients presenting at the echocardiography laboratory of a tertiary institution in the central region of South Africa

Introduction: Worldwide cardiovascular disease is associated with substantial economic challenges and profound morbidity and mortality. Considering the dearth of information for the central region of South Africa, this study aimed to assess the profile of patients who were referred to an echocardiography laboratory at a tertiary institution. Methods: A hospital-based, observational, descriptive study was conducted. Demographic, anthropometric, socio-economic, clinical and echocardiographic data were collected. Patients were categorised by hospitalisation status and reason for referral. Standard transthoracic echocardiograms were performed. Data were analysed using standard statistical software. Results: The study population had a mean age of 51.8±17.38 years, was predominantly black (64%) with a slight female preponderance (55%). The majority of patients were from a low-socioeconomic background (H0-H2; 91%). Most patients were from the Mangaung district (37%) and the referral pattern showed that regions with more hospitals tend to refer more patients for echocardiography. Alarmingly, two-thirds of the study population were hypertensive (64%) and 57% had a body mass index exceeding 25 kg/m2. Cardiology referred most patients for echocardiography (49%) and inpatient and outpatient referrals were almost equal (48% vs 52%). Abnormal echocardiographic findings were reported in 74% of patients with myocardial dysfunction being the most significant pathology (73%). Sixty-three percent of referrals were for routine echocardiographic assessment. Conclusion: This is the first study describing the profile of patients referred for echocardiography in the central region of South Africa. Travel distances and obtainability of health services appeared to have impacted referral patterns. Specific patterns of disease related to the individual referring specialist health care services. Hospitalisation status did not influence referrals.

Assessment of Voiding Dysfunction and Nocturnal Enuresis Rates in Primary School Children in Nablus, Palestine: A Cross-Sectional Study

Background: Voiding dysfunction (VD) is a frequent reason for primary care referrals to urologists and pediatric urologists. VD symptoms include urine incontinence (UI), urinary tract infection (UTI), hyperactive bladder, and constipation. Early detection of Nocturnal enuresis is critical due to its high frequency and the consequences for families and children regarding psychological and behavioral aspects. Objectives: This study aims to determine the prevalence of voiding disorder in Palestine and its relationship to demographic, family, and behavioral risk factors. Design: A cross-sectional study. Methods: This study administered a 2-part validated questionnaire to the mothers of primary school-age children who had no history of urological disease between December 2022 and March 2023. Results: Out of 169 children; daytime incontinence was found in 39 (23.2%) of the sample, whereas nocturnal enuresis was found in 49 (28.4%). Age was significantly correlated with voiding dysfunction, in which 25 (55.6%) were under the age of 7 years ( P = .025). Conclusion: According to our data, VD is a widespread health issue in primary school. Expanding our understanding of voiding dysfunction is important to eliminate the social stigma associated with voiding disorder and encourage parents and children to seek treatments and therapies. Furthermore, raising awareness will aid in early diagnosis, resulting in fewer long-term problems and earlier treatments. Raising awareness can be accomplished through educational programs focusing on primary care screening.

Clinical profile of children and adolescents with autism spectrum disorder in Durban, South Africa.

There are often delays in accessing care and diagnosing autism spectrum disorders (ASDs), with little data from Southern Africa on the clinical profile of affected children and adolescents. To describe the socio-demographic and clinical variables of children and adolescents with ASD attending psychiatric services at two state hospitals in eThekwini Municipality, KwaZulu-Natal province, South Africa. Two state hospitals in KwaZulu-Natal province, South Africa. The retrospective chart review examined patient records for the period 01 January 2018 to 31 December 2021. Data were collated using a structured data questionnaire on birth and family history, current presentation, comorbid conditions, medications, and non-pharmacological interventions. Of the 67 children and adolescents accessing care for ASD during the study period (including the coronavirus disease 2019 [COVID-19] pandemic lockdown period), most were males (89%), with a mean age standard deviation (s.d.) of 10.69 (s.d. 2.64) years. There was a delay between recognition of first symptoms and an ASD diagnosis of approximately three years. The most common reasons for referral were behavioural problems and speech delay, with 57 patients having delayed milestones (85%). Comorbid attention deficit hyperactivity disorder was reported in 55.2% (n = 37) of the patients and intellectual disability in 50.7% (n = 34), and the commonest comorbid medical condition was epilepsy (n = 20; 29.8%). All participants were on psychotropic medications, with 40 (59%) being on more than one agent. The delay in diagnosing ASD, high rates of comorbidity, and need for polypharmacy are concerning. The study highlights the need for greater awareness of ASD in communities and health care workers to expedite diagnosis and facilitate prompt psychosocial support and rehabilitation.

Advancing precision medicine through the integration of clinical cardiovascular genetics - An Asian perspective

PurposeThe integration of cardiovascular genetic (CVG) testing into clinical practice is gaining recognition, but its implementation in the Asian setting has not been widely reported. We present our experience developing a clinical CVG service and analyse its impact on patient care at our centre. MethodsIn 2020, National Heart Centre Singapore (NHCS) collaborated with SingHealth Duke-NUS Genomic Medicine Centre (SDGMC), to establish a comprehensive clinical CVG service. We retrospectively gathered details regarding referral indication and clinical utility of genetic counselling and testing. ResultsOver a period of two and a half years, 113 patients, aged 17 to 94 years old, were seen by the CVG team. The cohort included 79 males and 34 females: 82 of Chinese ancestry, 11 Indian, 7 Malay, and 13 from other ancestries. The most common reason for referral was for cardiomyopathy, followed by aortopathy. After clinical evaluation, 98 patients were offered genetic testing, of which 63 (64%) patients proceeded with genetic testing (diagnostic testing n=51, predictive testing n=10, familial segregation analysis n=2). Eleven patients were referred for continuation of care. Overall, CVG testing added value to the care of 44 patients by clarifying clinical diagnosis, ruling out inherited cardiac disorders, aiding variant of uncertain significance (VUS) resolution, and/or facilitating cascade testing. ConclusionOur pilot initiative has provided insights into the practical value, obstacles, and opportunities for developing a clinical CVG service. Establishment of our clinical CVG service not only enhanced patient care, but also demonstrated its scalability through collaborative partnerships with domain experts.

Referral reasons to a Victorian mental health triage service for individuals living with young-onset dementia.

Objectives Mental health triage services are the first contact for people wanting support for their mental health and provide access to public mental health services in Victoria, Australia. People living with young-onset dementia and their families may contact triage services seeking assistance for behaviour changes and pathways to care as there are few alternative services available. Methods The authors reviewed the minimum triage dataset from one of the largest mental health services in Victoria, Australia from 2018 to 2021 investigating reasons for referral for people with young-onset dementia. Results Of the 1766 referrals for 'dementia', 145 were for young-onset dementia. Of these, 69% were referred for behaviour changes. About half of the referrals for behaviour changes were triaged as 'advice only'. One-third of referrals were from general practitioners. Conclusions The availability of dementia-specific support services that could provide advice on dementia as well as advice for behaviour changes related to the disease could potentially ease the burden of phone calls received by mental health triage services.

Accidental findings of maxillary sinuses in dental patients on CBCT images. A retrospective study.

Background and objective: Maxillary sinus pathology is a common finding on routine CBCT scans of the maxilla. Hence the objective of this study is to define the frequency of accidental findings within maxillary sinuses on patients’ CBCT images that are referred for various dento-alveolar reasons in the maxilla and to evaluate the relation of the age and gender with the maxillary sinus condition. Methods: A total of 255 sequential CBCT scans from patients aged between 15-78 years, with a localized field of view (8.0cm x 5.0 cm) were retrospectively included in the analysis, resulting in an evaluation of 510 maxillary sinuses. The findings were categorized as healthy sinus, mucosal thickening, polypoid thickening and partial opacification. Result: Out of 255 patients, 148 (58%) were males and 107 (42%) were females with a mean age of 50.23 (SD=19.08). Implant assessment was the major request 206 (80.8%) followed by exploration of impacted teeth 35 (13.7%). 52.2% of included cases showed sinuses with no pathology (NP). 47.8% showed accidental findings of which mucosal thickening (MT) was the highest 104 (40.8%). The relationship between gender and maxillary sinus status was statistically non-significant (p=0.346). The relation of the age (≤50 and >50) and sinus status, however, was statistically significant (p=0.035). Conclusion: According to the present study results, the most common referral reasons for CBCT examination were for implant assessment. Mucosal thickening was the highest among the pathologic findings in the maxillary sinus. There was no significant relationship between gender and maxillary sinus status but there was a statistically significant relationship between age and findings. Keywords: CBCT, Maxillary sinus, incidental pathologies, Accidental findings, mucosal thickening.

A Comprehensive electroencephalogram audit in a tertiary care center in Pakistan: demographic distribution, referral indications and findings

Background and Objective:
 Electroencephalography (EEG) is a widely employed non-invasive technique for recording brain electrical activity, pivotal for diagnosing various neurological conditions. The study aims to provide insight into demographic distribution, referral indications, and EEG findings in a tertiary care hospital in Pakistan.
 
 Methods:
 A retrospective cross-sectional analysis was conducted involving 2,924 patients who underwent routine EEG evaluations over a three-year period. Data was collected from the EEG records after approval from the ethical review committee. Demographic variables, referral reasons, and EEG findings were recorded and analyzed using descriptive statistics.
 
 Results:
 The study revealed a gender distribution of 41.35 % females and 58.65 % males, aligning with broader epidemiological trends. Participants were categorized into different age groups and most of the patients in our study belonged to the five to 18 years of age group. Most common indication was a suspected seizure disorder (78.32 %), followed by subclinical seizures (7.38 %) and medication adjustment (6.81 %). Notably, encephalopathy was the most common abnormal EEG finding (31 %), with temporal epilepsies being predominant within the focal seizure category.
 
 Conclusion:
 The descriptive nature of the study contributes novel insights. The study’s contribution provides valuable guidance for healthcare professionals, enhancing their comprehension of neurological conditions and refining diagnostic and treatment strategies.

Culturally appropriate psychotherapy and its retention: An example from Far North Queensland (Australia)

BackgroundCulturally appropriate mental health care is essential in remote Australia. However, while associated with the development of an effective therapeutic alliance, current literature insufficiently reports the retention and psychotherapy outcomes of Indigenous adults. We aimed to describe the characteristics and retention of clients attending the Far North Mental Health and Wellbeing Service (FNS). MethodsWe conducted a retrospective cross-sectional study on clients who received one or more psychotherapy consultations between 1st July 2019 and 31st December 2020. Population, entrance, and treatment characteristics were described, with retention compared between the major cultural groups. Entrance characteristics comprised referral pathway and reason for presentation and were investigated as alternative predictors of client retention. FindingsThere were 186 non-Indigenous (68.3 % female) and 174 Indigenous (62.6 % female) clients, with a median number of 3.0 consultations (IQR 2.0–5.3). Indigenous status did not significantly predict retention. Referral pathway significantly predicted the number of consultations (Wald X2(6) = 17.67, p = .0071) and immediate discontinuation (Wald X2(6) = 12.94, p = .044), with self-referred clients having the highest retention. Initial presentation reason significantly predicted the number of consultations (Wald X2(5) = 13.83, p = .017), with clients with potential health hazards related to socioeconomic and psychosocial circumstances having the lowest retention. Significantly more Indigenous clients presented for this reason (20.1 % vs 4.3 %). InterpretationComparable retention of Indigenous clients suggests cultural appropriateness of the psychotherapy being delivered by the FNS. Services might use the described therapeutic approach as a guide for culturally appropriate care.

Evaluation of a community-based intervention for youth mental health in rural Ireland.

This study aimed to provide information about pathways to care and clinical response to community-based brief interventions for improving youth mental health through evaluating the Mindspace Mayo service. Participants were 1,184 individuals aged 12-25 years (Mean = 17.92, SD = 2.66) who engaged with the Mindspace service. Demographic information included gender, age and living situation. The Clinical Outcome in Routine Evaluation (CORE) was used to measure psychological distress before and after attending the Mindspace service between February 2015 and 2022. On average, individuals received six sessions of therapeutic support. Analyses indicated that most referrals were made by either a parent (40%) or self-referral (38%). The most frequent reason for referral was mood and anxiety-related issues. Across the entire sample, reductions in CORE scores were both statistically and clinically significant. Neither the source of the referral nor living situation significantly predicted intervention response. Complexity of issues presented at referral significantly predicted a reduction in psychological distress post-intervention in young people aged over 17 years. This study highlighted the value of primary care mental health services for young people aged 12-25 years, and underlined the importance of recording electronic data to track referral pathways, reasons for referral and the intervention outcomes over time.

Chromosome 9 aberrations diagnosed at a pediatric hospital in Tabasco, Mexico

Objective. To determine the frequency of patients diagnosed with chromosome 9 disorders in a pediatric hospital between the years 2012 and 2022. Materials and methods. A cross-sectional and descriptive study was performed in 2932 patients who attended the genetics consultation of a pediatric hospital in Tabasco, Mexico, from January 2012 to December 2022, based on the results of chromosomal diagnosis in peripheral blood. Results. Chromosomal alterations were present in 14.76% (433/2932). The most frequently involved chromosome was number 21 in 83.37% (361/433), followed by sex chromosome X with 5.31% (23/433) and chromosome 9 with 3.69% (16/433). Regarding chromosome 9, 50% (8/16) corresponded to morphological variants (9qh+), followed by pericentric inversion in 3 of the cases (18.75%), deletion in 2 (12.5%), insertion in 1 (6.6%), ring in 1 (6.6%), and a shunt (6.6%). Conclusion. The cytogenetic results found, according to the patients' reasons for referral, suggest the performance of peripheral blood karyotyping as a useful tool in the diagnosis of diseases with genetic suspicion. Key words: Chromosomal inversion; Karyotype; Infertility.

Diagnostic concordance in consultation liaison psychiatry – Referring physicians to psychiatrists

Psychiatric co-morbidity in patients with physical illness is known to influence the course and outcome of both conditions. Consultation liaison psychiatry [CLP] can be regarded as an essential service between psychiatry and other medical specialties. Efficient communication between different levels of care is known to have an impact on the quality of health care. To study the patterns of referrals to the department of psychiatry and diagnostic concordance between referring physicians to CL-Psychiatrist.The present study was a cross-sectional study conducted in the Department of Psychiatry of a tertiary care hospital. All the patients referred to the Psychiatry department for 4 months were taken after excluding referrals sent for disability assessment. Socio-demographic details, source of referral, reason for referral, and the psychiatric diagnosis by both the referring doctor and CL-psychiatrist were recorded. Statistical analysis was done using SPSS 25.0 software and kappa value was used to estimate the diagnostic concordance.In the sample of 100 referrals studied, the mean age of the sample was 40.96±13.42 years. The majority of the cases referred were inpatients (61%), from the department of general medicine and allied branches (85%), (General medicine -55, Neurology- 21). The most common diagnosis was alcohol dependence syndrome 24 (24%), followed by depression (18%) and phobic anxiety (18%).The concordance of the diagnosis between the referral and the psychiatry team was in perfect agreement (κ=0.81- 1.00) for paranoid schizophrenia, bipolar affective disorder, delirium, dissociative disorder, delusional disorder, and alcohol dependence syndrome. Very low concordance was observed in diagnosing obsessive-compulsive disorder (k=0) and adjustment disorder (k=0).The overall diagnostic concordance was poor for adjustment disorder, OCD, and vascular dementia, and good for paranoid schizophrenia, delirium, dissociative disorder, delusional disorder, and BPAD.

Maternal and Perinatal Outcome in Severe Pre-eclampsia in a Tertiary Care Center

Background: Pre-eclampsia is the leading reason for referrals to a specialized healthcare facility, as it represents a significant contributor to maternal and perinatal morbidity and mortality. Objective: The objective of this study is to examine the maternal and fetal outcomes associated with severe pre-eclampsia in a Tertiary Care Center. Design: Prospective observational study. Methodology: This prospective observational study took place at Dr. Prabhakar Kore Hospital and MRC, located in Belagavi and affiliated with KAHER's Jawaharlal Nehru Medical College, Belagavi. The study spanned from January 1, 2021, to December 31, 2021. Pregnant women diagnosed with severe Pre-eclampsia, which met the specified inclusion and exclusion criteria, and were admitted to the labor room at the tertiary care center, were enrolled in the study. Results: Participants in the study ranged in age from 19 to 41 years, with a mean gestational age at diagnosis of 35.32 weeks ±3.7 weeks. Among the participants, 73.4% underwent lower segment cesarean section (LSCS), while 22.4% had vaginal deliveries, including 3 cases with instrumental delivery (ventouse). The study observed increased incidences of Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome (32.4%), placental abruption (30%), postpartum hemorrhage (22%), partial HELLP syndrome (16.2%), pulmonary edema (11%), eclampsia and disseminated intravascular coagulation (DIC) (8.1%). The incidence of prematurity was 55%, and intrauterine fetal demise (IUFD) occurred in 7% of the cases. Conclusion: Maternal and perinatal problems are more common in eclampsia patients. Better prenatal care, early detection, and timely treatment of severe pre-eclampsia can lower the incidence of eclampsia.