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Referral pathway

Abdulla Ibrahim, Mahmoud K Nassar, Daniel J Jordan, Manish Sinha, Fiona J Hogg
The Adult Exceptional Aesthetic Referral Protocol (AEARP) encompasses a series of aesthetic procedures which, as they do not treat an underlying disease process, are not routinely available within the National Health Service. Provision of these services can only be provided on an exceptional basis. In this prospective study, we evaluated the referral process and outcomes of 1122 patients referred under the AEARP over a 3.5-year period. Referrals were screened by a vetting panel comprising of a plastic surgeon, clinical nurse specialist, and clinical psychologist...
May 22, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Luke S Midgley, Simon Murphy, Graham Moore, Gillian Hewitt, James White
OBJECTIVES: To examine whether young peoples' risk of cannabis, mephedrone and novel psychoactive substances (NPS) use is associated with school substance-misuse policy. DESIGN: A cross-sectional survey of secondary school students combined with a School Environment Questionnaire and independently coded school substance-misuse policies (2015/6). SETTING: 66 secondary schools in Wales. PARTICIPANTS: Students aged 11-16 years (n=18 939)...
June 14, 2018: BMJ Open
J F Vázquez-Costa, M Martínez-Molina, M Fernández-Polo, V Fornés-Ferrer, M Frasquet-Carrera, T Sevilla-Mantecón
INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is an insidious, clinically heterogeneous neurodegenerative disease associated with a diagnostic delay of approximately 12 months. No study conducted to date has analysed the diagnostic pathway in Spain. METHODS: We gathered data on variables related to the diagnostic pathway and delay for patients diagnosed with ALS between October 2013 and July 2017. RESULTS: The study included 143 patients with ALS (57% men; 68% spinal onset)...
June 11, 2018: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Emmanuel A Tsochatzis, Philip N Newsome
Non-alcoholic fatty liver disease (NAFLD) has a prevalence of 25-30% in unselected populations and has become the main reason for referrals to hepatology services. From the perspective of liver disease, NAFLD has a high prevalence but low severity. Screening studies in people at risk for NAFLD have shown a prevalence of advanced fibrosis of 5%, which underlines the need for robust pathways for risk stratification in primary care, with subsequent referrals as required. In this Review, we discuss the interface between primary and secondary care with regards to risk stratification and management of patients with NAFLD...
July 2018: Lancet. Gastroenterology & Hepatology
Guilherme Augusto Stirma, Christiano Saliba Uliana, Weverley Rubele Valenza, Marcelo Abagge
Objective: To report a series of cases of patients treated by fracture of the femoral head through the Ganz pathway with controlled dislocation of the hip. Method: All patients who were surgically treated with a Ganz access route for femoral head fractures were identified in a tertiary referral service for trauma. A review of medical records with X-rays and CT scans was carried out. The radiographic evaluation was classified according to Pipkin and the functional evaluation was performed through the application of the modified Harris Hip Score...
May 2018: Revista Brasileira de Ortopedia
Lennart Reifels, Angela Nicholas, Justine Fletcher, Bridget Bassilios, Kylie King, Shaun Ewen, Jane Pirkis
Background: Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers...
2018: Global Health Research and Policy
Shamil Haroon, Darren Wooldridge, Jan Hoogewerf, Krishnarajah Nirantharakumar, John Williams, Lina Martino, Neeraj Bhala
BACKGROUND: Alcohol misuse is an important cause of premature disability and death. While clinicians are recommended to ask patients about alcohol use and provide brief interventions and specialist referral, this is poorly implemented in routine practice. We undertook a national consultation to ascertain the appropriateness of proposed standards for recording information about alcohol use in electronic health records (EHRs) in the UK and to identify potential barriers and facilitators to their implementation in practice...
June 7, 2018: BMC Medical Informatics and Decision Making
Claudia Marotta, Carlo Giaquinto, Francesco Di Gennaro, Kajal D Chhaganlal, Annalisa Saracino, Jorge Moiane, Guido Maringhini, Damiano Pizzol, Giovanni Putoto, Laura Monno, Alessandra Casuccio, Francesco Vitale, Walter Mazzucco
BACKGROUND: In 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for HIV positive children < 5 years old. A retrospective, pre-post intervention study was designed to evaluate effectiveness of a new pathway of care in a sample of Beira District Local Health Facilities (LHFs), the primary, local, community healthcare services. METHODS: The study was conducted by accessing registries of At Risk Children Clinics (ARCCs) and HIV Health Services...
June 7, 2018: BMC Public Health
Felicity Mayer, Debra Bick, Cath Taylor
BACKGROUND: Cardiac disease is associated with adverse outcomes in pregnancy and is the leading cause of indirect maternal death in the United Kingdom (UK) and internationally. National and international guidelines recommend women should receive care from multidisciplinary teams; however evidence is lacking to inform how they should be operationalised. OBJECTIVES: To describe the composition and processes of multidisciplinary care between maternity and cardiac services before, during and after pregnancy for women with cardiac disease, and explore clinicians' (cardiologists, obstetricians, nurses, midwives) and women's experiences of delivering/receiving care within these models...
May 22, 2018: International Journal of Nursing Studies
Emma Pullen, Dominic Malcolm, Patrick Wheeler
BACKGROUND: Regular participation in sport, exercise and physical activity is associated with positive health outcomes and form a mainstay of British public health policies. However, regular participation in sport and exercise can result in sport related injury (SRI) which, in turn, is a key cause of exercise cessation. The integration of Sport and Exercise Medicine (SEM) in the English National Health Service (NHS) aims to provide a specialist service for public populations and thus reduce the impact of SRI on exercise cessation and associated negative health outcomes...
June 7, 2018: Journal of Sports Medicine and Physical Fitness
M J Berney, A McGillivary, J Caird, D J Murray
Sagittal synostosis (SS) is the commonest form of craniosynostosis. Children with sagittal synostosis in Ireland are treated in the National Paediatric Craniofacial Centre (NPCC) in Temple Street Children's University Hospital. This retrospective study analysed the correlation between referral patterns to the unit and age at operation. The notes of 81 patients referred over a 5-year period (April 2008 - April 2013) to the NPCC with non-syndromic SS were reviewed and demographics and referral information were recorded...
January 10, 2018: Irish Medical Journal
Johan Kakko, Charlotte Gedeon, Mikael Sandell, Henrik Grelz, Inge Birkemose, Thomas Clausen, Valgerður Rúnarsdóttir, Kaarlo Simojoki, Richard Littlewood, Hannu Alho, Fred Nyberg
BACKGROUND: Long-term use of opioid analgesics (OA) for chronic pain may result in opioid use disorder (OUD). This is associated with adverse outcomes for individuals, families and society. Treatment needs of people with OUD related to chronic pain are different compared to dependence related to use, and also injection, of illicit opioids. In Nordic countries, day-to-day practical advice to assist clinical decision-making is insufficient. AIM: To develop principles based on expert clinical insights for treatment of OUD related to the long-term use of OA in the context of chronic pain...
June 1, 2018: Substance Abuse Treatment, Prevention, and Policy
Orna Fennelly, Catherine Blake, Oliver FitzGerald, Roisin Breen, Jennifer Ashton, Aisling Brennan, Aoife Caffrey, François Desmeules, Caitriona Cunningham
BACKGROUND: Many people with musculoskeletal (MSK) disorders wait several months or years for Consultant Doctor appointments, despite often not requiring medical or surgical interventions. To allow earlier patient access to orthopaedic and rheumatology services in Ireland, Advanced Practice Physiotherapists (APPs) were introduced at 16 major acute hospitals. This study performed the first national evaluation of APP triage services. METHOD: Throughout 2014, APPs (n = 22) entered clinical data on a national database...
June 1, 2018: BMC Musculoskeletal Disorders
Jessica Goldberg, Jessica Greenstone Winestone, Rebecca Fauth, Melissa Colón, Maria Verónica Mingo
INTRODUCTION: Conducted as part of the Massachusetts MIECHV evaluation, this study examined the role of home visitors (HVs) in facilitating families' connections to early childhood systems of care. The aims of this study were to document the full range of HV behaviors related to service coordination. METHODS: The study sample was 65 participant cases from five program sites, comprising two home visiting models (HFM and PAT). We coded and analyzed 11,096 home visiting records, focusing on identifying referrals, connections, disconnections, and supportive behaviors across 20 service areas...
June 2, 2018: Maternal and Child Health Journal
Anna B Johnson, Shanna B Mliner, Carrie E Depasquale, Michael Troy, Megan R Gunnar
Poverty is associated with poor physical and emotional development. Activation of the hypothalamic-pituitary-adrenocortical (HPA) axis is argued to be one of the pathways through which poverty acts on these outcomes. While studies of school-aged children have found some evidence for this, there is little evidence for this hypothesis early in development. This may be, in part, because for very young children, the security of their attachment relationships with parents moderates the impact of poverty on HPA axis functioning...
May 22, 2018: Psychoneuroendocrinology
Paul T G Davies, Russell J M Lane, Theresa Astbury, Manuela Fontebasso, Jill Murphy, Manjit Matharu
AimTo outline the pathways a cohort of first attendees to our headache clinics had taken over the years in search of explanations and treatment for their headaches. To establish a greater awareness of the shortcomings and failures in their medical journey in the hope that better headache management will emerge in primary care. BACKGROUND: At first attendance in primary care most headache sufferers will not receive a firm diagnosis. Treatments provided are often ineffective and so many patients embark on a somewhat random self-made journey searching for a remedy...
May 31, 2018: Primary Health Care Research & Development
Barry Kevane, Seamus Allen, Kevin Walsh, Karl Egan, Patricia B Maguire, Marie C Galligan, Damien Kenny, Rhona Savage, Esther Doran, Áine Lennon, E Laine Neary, Fionnuala Ní Áinle
AIMS: The mechanisms underlying the competing thrombotic and hemorrhagic risks in Eisenmenger syndrome are poorly understood. We aimed to characterise derangements of blood coagulation and to assess the effect of dual endothelin-1 receptor antagonism in modulating hemostasis in this rare disorder. METHODS: In a 10 month recruitment period at a tertiary cardiology referral centre during which time there were over 14,000 out-patient consultations, consecutive subjects with Eisenmenger syndrome being considered for macitentan therapy (n=9) and healthy volunteers (n=9) were recruited...
May 26, 2018: Journal of Thrombosis and Haemostasis: JTH
Charlie Brooker, Sheila Paul, Coral Sirdifield
A national survey of Forensic Physicians (FPs) working in Sexual Assault Referral Centres was undertaken. The survey was advertised in the weekly bulletin sent out by the Faculty of Forensic and Legal Medicine. Response was relatively low (n = 45). It is estimated that this figures represents about 12% of the workforce. The aim of the survey was to investigate FPs experience of accessing mental health pathways out of a SARC for complainants of all ages. The results concurred with a previous survey of SARC clinical managers with mental health services proving unresponsive...
May 22, 2018: Journal of Forensic and Legal Medicine
Peter G Kranz, Linda Gray, Timothy J Amrhein
OBJECTIVE: To discuss common myths and misperceptions about spontaneous intracranial hypotension (SIH), focusing on common issues related to diagnosis and treatment, and to review the evidence that contradicts and clarifies these myths. BACKGROUND: Recognition of SIH has increased in recent years. With increasing recognition, however, has come an increased demand for management by neurologists and headache specialists, some of whom have little prior experience with the condition...
May 24, 2018: Headache
Rebecca E Johnson, Oyinlola Oyebode, Sadie Walker, Elizabeth Knowles, Wendy Robertson
OBJECTIVE: The Eat Well Move More (EWMM) family and child weight management service is a 12-week intervention integrating healthy eating and physical activity education and activities for families and children aged 4-16. EWMM service providers identified low uptake 12 months prior to the evaluation. The aims of this study were to describe referral practices and pathways into the service to identify potential reasons for low referral and uptake rates. RESULTS: We conducted interviews and focus groups with general practitioners (GPs) (n = 4), school nurses, and nursing assistants (n = 12)...
May 21, 2018: BMC Research Notes
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