scholarly journals EP.TH.81Contribution of Information on GP Referral Letters to Patient Management in a Rapid-diagnosis Breast Clinic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Eleonora Gkigkelou ◽  
Katharine Kirkpatrick ◽  
Duraisamy Ravichandran
Keyword(s):  
Family History ◽  
Patient Management ◽  
Median Number ◽  
Irrelevant Information ◽  
Rapid Diagnosis ◽  
Initial Assessment ◽  
Patient Questionnaire ◽  
Referral Letter ◽  
Breast Clinic ◽  
Referral Letters

Abstract Aims GP referral letters to rapid-diagnosis breast clinics are often poorly scanned copies of standard 2 week-wait proforma that are difficult to read, lengthy, and contain a large amount of irrelevant information. We studied the contribution of information in referral letters in patient management and compared this with information provided by patients themselves. Methods Patients completed a standard questionnaire (one side of A4) on arrival at clinic. This included all information relevant to a breast clinic such as family history and comorbidities. A consultant surgeon then saw the patients with the questionnaire and performed clinical assessment and imaging as necessary, without referring to GP letters. The letters were read before patients left clinic. Any additional useful information was noted. Results 202 consecutive new patients, median age 44 (16-93) seen in 23 clinics by 2 consultants were studied. The median number of pages in referral letter was 5 (1-14). Patient questionnaire took less than 30 seconds to read. The presenting complaints were real or perceived lump (n = 105), pain (n = 44), both (n = 14) and others (n = 39). 21 patients had cancer. Additional useful information in the referral letter was noted in 20 patients (10%). However, in no case this affected the patient management adversely. Conclusions GP letters are lengthy but contribute relatively little to the initial assessment and management of patients in a busy rapid diagnosis breast clinic. A patient-completed targeted questionnaire is quicker and can potentially replace a GP referral letter in most patients.

Retrospective Analysis of Intra-Departmental Requests for Consultation To Hematology Department

2021 ◽  
Vol 15 (11) ◽  
pp. 3141-3142
Author(s):  
Irfan Khan ◽  
Muhammad Muneeb ◽  
Shahzeb Ahmed ◽  
Muhammad Haseeb ◽  
Muhammad Bin Usman ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Retrospective Study ◽  
Retrospective Analysis ◽  
Bone Marrow Biopsy ◽  
Initial Assessment ◽  
Referral Letter ◽  
Referral Process ◽  
Medicine Department ◽  
Referral Letters

Aim: To investigate how much information a specialist hematologist receives at the time of initial assessment of referred patients through a referral letter. Study design: Retrospective study Place and duration of study: Haematology department BVH, October 2020 to February 2021 (5 months) Methods & Results: Among the 96 referral letters received, Majority 45 (47%) was referred from medicine department. Most common reason for referring the patient was evaluation of Pancytopenia n=19 (19.8%), Request for bone marrow biopsy n=14 (14.6%), being the second most common. The reason for referral was not properly stated in n=9 (9.4%) of patients in our study. Majority of referred patients were above 46 years of age n=22 (22.9%). CBC was mentioned only in n=35 (36.5%). Conclusion: Our study concludes that quality of referral letter was well below the acceptable standards. A well-documented protocol for referral letter is the need of hour to improve the quality of a referral process. Keywords: referral letter, pancytopenia, bone marrow, hematology clinics

scholarly journals Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

2020 ◽  
Vol 9 (1) ◽  
pp. 75-84
Author(s):  
Alison Anthony ◽  
Reinhard Zeller ◽  
Cathy Evans ◽  
Jennifer A. Dermott
Keyword(s):  
Family History ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Geographic Location ◽  
Initial Assessment ◽  
Brace Treatment ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Curve Magnitude

Abstract Study design Retrospective cross-sectional study. Objective To analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines. Summary of background data There is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection. Methods We performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10–18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude. Results During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence. Conclusion The majority of AIS patients present too late for effective management with bracing. Level of evidence III.

scholarly journals Mammography in Symptomatic Women Attending a Rapid Diagnosis Breast Clinic: A Prospective Study

2006 ◽  
Vol 88 (3) ◽  
pp. 306-308 ◽  
Author(s):  
MJP Biggs ◽  
D Ravichandran
Keyword(s):  
Breast Cancer ◽  
Significant Proportion ◽  
Management Plan ◽  
Clinical Findings ◽  
Rapid Diagnosis ◽  
Breast Cancers ◽  
Breast Clinic ◽  
Breast Radiologist ◽  
A Prospective Study ◽  
Symptomatic Breast

INTRODUCTION We determined whether it is safe to avoid mammograms in a group of symptomatic women with a non-suspicious history and clinical examination. PATIENTS AND METHODS Symptomatic women aged 35 years or over newly referred to a rapid-diagnosis breast clinic underwent mammography on arrival in the clinic. A breast radiologist reported on the mammograms. An experienced clinician who was unaware of the mammogram findings examined patients and decided whether a mammogram was indicated or not. If not, a management plan was formulated. Mammogram findings were then provided to the clinician and any change to the original management plan as a result of mammography was recorded. RESULTS In two-thirds (67%) of 218 patients, the clinician felt a mammogram was indicated. Half (46%) of these mammograms showed an abnormality; of these abnormal mammograms, 41% were breast cancer. Among the third (n = 71) of mammograms felt not to be indicated, 3 showed abnormalities of which 2 were breast cancer. One cancer was not suspected clinically or mammographically but was diagnosed on cyto/histopathological assessment. CONCLUSIONS A significant proportion of patients attending a symptomatic breast clinic have a non-suspicious history and normal clinical findings on examination. However, even in this group avoiding mammograms risks missing clinically occult breast cancers. It would appear sensible to offer mammograms to all symptomatic women over 35 years of age.

Rates of appropriate genetic testing referral for breast cancer patients treated in a multidisciplinary cancer care setting.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 45-45 ◽  
Author(s):  
Caitlin Laurel Gomez ◽  
Nicole Ann Dawson ◽  
Robyn Lynn Dvorak ◽  
Nova Foster ◽  
Anne Hoyt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Family History ◽  
Genetic Counselor ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Breast Clinic ◽  
Jewish Ancestry ◽  
The Impact ◽  
Genetics Referral

45 Background: Approximately 5% to 10% of women diagnosed with breast cancer have a genetic predisposition, which can affect management recommendations. The National Comprehensive Cancer Network (NCCN) has established guidelines for genetics referral and testing, however recent publications have indicated low rates of family history documentation and appropriate genetics referral. We sought to assess the impact of standardized family history documentation on rates of appropriate genetics referral in a multidisciplinary breast clinic (MDC) setting. Methods: In advance of MDC consultation, women with newly diagnosed breast cancer complete an intake questionnaire which includes documentation of Ashkenazi Jewish ancestry along with a thorough family history. We retrospectively analyzed family history documentation to inform eligibility for genetic testing and rates of appropriate genetics referral. Results: Between June 2012 and April 2014, 202 women with newly diagnosed, nonmetastatic breast cancer were seen in MDC. We noted 100% compliance with family history documentation. Per NCCN Guidelines, genetic testing was indicated in 52% (106 patients), of which 77% were appropriately referred to a genetic counselor for evaluation. All patients who met criteria based on personal history factors including age ≤ 45, triple-negative disease under age 60, or two or more breast primaries under age 50 were appropriately referred. Patients who were eligible but not referred ranged in age from 46 to 93 and were eligible for testing based on Ashkenzi Jewish ancestry (3 patients) or family history factors including a relative with ovarian cancer (3 patients), ≥2 relatives with breast cancer (5 patients), or a relative with breast cancer < age 50 (7 patients). Conclusions: Compared with recently published national averages, rates of appropriate family history documentation and genetic testing referrals are significantly higher in our MDC setting. However, this analysis has identified significant opportunity for improvement via identification of overlooked referral indications. Initiatives are underway to improve future compliance.

scholarly journals Punch biopsy: A useful adjunct in a rapid diagnosis breast clinic

The Breast ◽  
2010 ◽  
Vol 19 (2) ◽  
pp. 150-151 ◽  
Author(s):  
B.N. Modi ◽  
J.T. Machin ◽  
D. Ravichandran
Keyword(s):  
Punch Biopsy ◽  
Rapid Diagnosis ◽  
Breast Clinic

Analysis of referral letters to a department of old age psychiatry

2008 ◽  
Vol 25 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Fiona Campbell ◽  
Brian Parsons ◽  
Ruth Loane
Keyword(s):  
Old Age ◽  
Referral Letter ◽  
Ageing Population ◽  
Next Of Kin ◽  
Referral Management ◽  
Referral Form ◽  
Outpatient Departments ◽  
Old Age Psychiatry ◽  
Clinical Records ◽  
Referral Letters

AbstractObjective: There is a paucity of literature on the content of referral letters to psychiatric services and few relating specifically to referrals to a department of old age psychiatry. There has been a significant increase in referrals over the last five years to this service, which may reflect the ageing population and a greater awareness of the service. Our objective was to evaluate the quality and legibility of information received, clarity of reason for referral and details of pre-referral management.Methodology: The clinical records of the first 100 referrals in 2002 to this department were analysed. The referral letters were examined for the documentation of a number of demographic variables, reason for referral, interventions to date and level of urgency.Results: The clinical records of nine patients did not have an identifiable referral letter at the time of this analysis. Of the remaining 91 analysed, 59% were referred by their GP, 33% were inpatient liaison referrals and 8% from outpatient departments. In the majority, patients' details were given, however, only 30% included a phone number. Next-of-kin was mentioned in 29%. GP's name was included in 71% of referrals from OPD and 7% of liaison referrals. The level of urgency was stated in 19%. Whether a domiciliary or OPD visit would be more appropriate was stated in 22%. The reason for referral was clear in 75%, with 43% including some aspect of Mental State Examination, 7% had included a MMSE score, 1% mentioned level of suicide risk.Thirty-one per cent had pre-referral investigations and 45% had pre-referral treatment documented. The letters were clearly legible in 73%.Conclusion: The information in the referral letter in many cases was insufficient to prioritise and expedite appropriate assessment. It is planned to introduce a proforma referral form, specific to old age psychiatry, which would include the information which is required and which would, hopefully, lead to a more efficient service.

A LOCAL SURVEY AMONGST 92 PATIENTS WITH MULTIPLE SCLEROSIS: WHAT CAN WE LEARN ABOUT THIS POPULATION'S DISEASE MANAGEMENT? HOW SATISFIED ARE PATIENTS WITH OUR SERVICE?

2015 ◽  
Vol 86 (11) ◽  
pp. e4.4-e4
Author(s):  
James Bashford ◽  
Eli Silber
Keyword(s):  
Mental Health ◽  
Bone Health ◽  
Patient Management ◽  
Symptom Burden ◽  
Dual Energy ◽  
Primary Data ◽  
Patient Questionnaire ◽  
Depression And Anxiety ◽  
X Ray ◽  
Anxiety Depression

In order to better inform local clinical practice, we collected primary data from our local MS population. We addressed important aspects concerning relapse management, bone health, mental health, sphincter dysfunction, symptom burden, recognition of comorbidities and pharmacological treatment. An emphasis was placed on discovering the extent of patient satisfaction with the local service.An 11-page patient questionnaire was distributed to consecutive consenting patients attending the MS clinic. A supplemental questionnaire was provided to those patients on regular natalizumab therapy. In total, 92 full and 22 natalizumab questionnaires were completed.Two particular areas highlighted for improvement with regards to patient management and patient education were bone and mental health:1. Only 26% of respondents confirmed having had a dual-energy X-ray absorptiometry (DEXA) scan. When asked if reduced ability in MS is an important risk factor for osteoporosis, only 44/92 patients confirmed they thought this was true.2. In the last year, 41% and 58% of respondents have suffered from depression and anxiety, respectively. Despite this, only a third of these patients received any treatment (pharmacological or non-pharmacological) for anxiety, depression or both.Encouragingly, 95% of those surveyed would recommend our MS service to a friend or family member.

scholarly journals Perancangan Sistem Informasi Mutasi Siswa SMA pada Dinas Pendidikan Provinsi Jawa Barat

Petir ◽  
2019 ◽  
Vol 12 (2) ◽  
pp. 262-270
Author(s):  
Meliyana Dwi Cahya ◽  
Leonardi Paris Hasugian
Keyword(s):  
High School ◽  
Information System ◽  
School Development ◽  
Referral Letter ◽  
The West ◽  
Education Services ◽  
Registration Process ◽  
File Storage ◽  
A Company ◽  
Referral Letters

The West Java Provincial Office is a company engaged in education services, which has several parts, one of which is the High School Development (PSMA) field. PSMA itself has not used an information system in the registration process of student mutations, where problems faced by registrants want to request a mutation referral letter, referral letters are not always completed on time. registrars do not know the flow of procedures, and other constraints are on file storage that tends to accumulate. The purpose of the study is to notify the registrant that a referral letter has been completed, notify the registrant of the path - what paths must be done by the registrant and make it easier when searching the file for the registration mutation. The method used, namely using descriptive methods. which is aimed at gathering information about a problem. The results of this study are to notify the registrant that the referral letter has been completed or processed, notify the registrant of the path - what paths the registrant must do, and make it easier when searching the file for the registration mutation.

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