Glaucoma screening skills among general ophthalmologists - How general should it be?

Purpose: To compare the glaucoma assessment skills among general ophthalmologists in their referral patients over 5 years. Methods: This was a retrospective auditing of the electronic medical record database. Details of consecutive new glaucoma patients seen in the glaucoma services of a tertiary eye care institute in 2013 and 2018 were collected. Details of each patient included the clinical presentation, baseline intra?ocular pressure (IOP), type and severity of glaucoma, referral details, gonioscopy, HVF (Humphrey visual field) data, and the number of medications. Statistical tests used were the Chi?square test and T test using SPSS version 22. Results: Of 28,886 medical records screened, 211 and 568 new glaucoma patients were retrieved in 2013 and 2018, respectively. The patients presenting in 2018 were younger (58.1 ± 15.4 years) at presentation than in 2013 (65.6 ± 15.2 years), P < 0.01, and also had higher baseline IOP (IOP ?40 mm Hg was found in 9.5% in 2018 versus 2.4% in 2013; P < 0.01). The percentage of eyes with presenting visual acuity worse than 20/400 or 20/600 was higher in the patients presenting in 2018 (22.2% vs. 15.1%; P = 0.03). Although primary glaucoma predominated in both periods, the number of eyes referred to as disc suspects showed an increase in 2018 (4.7% to 14.4%; P < 0.01). Among 195 and 517 referrals in 2013 and 2018, respectively, the documentation of clinical findings were dismally poor in both the groups in terms of absent gonioscopy (99% vs. 98.2%, P = 0.4), absent disc details (89.6% vs. 91%, P = 0.5), or absent visual field analysis (79.1% vs. 74.8%, P = 0.2). However, the missing IOP values were significantly better in the latter year (77.3% vs. 57.2%; P < 0.01). Conclusion: The increase in the number of new glaucoma patients and referrals did not show a corresponding improvement in documentation of findings except for IOP recording among general ophthalmologists. Hence, we need to re?emphasize the training of general ophthalmologists on basic glaucoma evaluation to improve their referral ability

Teleconsultations in neurology in a universal health system amid COVID-19: a descriptive study

SUMMARY OBJECTIVE: This study aimed to characterize teleconsultations in neurology executed by Regula+Brasil project in Recife, a capital city in northeastern Brazil. METHODS: A descriptive study carried out by four private hospitals, in a partnership with the Ministry of Health in Brazil. Teleconsultation was performed preferably in the video modality. Conditions eligible for teleconsultation were headache, epilepsy, and cerebrovascular disorders. Period of analysis was May to September 2020. RESULTS: A total of 243 teleconsultations were analyzed, of which 76.95% was a first appointment. In 48.97% of cases, the teleconsultation represented the first opportunity for the patient to be consulted with the specialist. Among cases of first appointment, 20.16% were further referred to a face-to-face consultation and 21.81% could be redirected to primary health care. Headache disorders were the most predominant clinical conditions. CONCLUSIONS: The implementation and development of telemedicine by Regula+Brasil during the COVID-19 pandemic represented an opportunity to assess the value of having teleconsultations added along the line of care from primary care to a medical specialty, promoting the coordination of care across different levels of complexity of care in the health system and improving access to specialized care.

Reducing medication has become a privilege of wealth in western settings

In 20th century healthcare in affluent settings, generating awareness of the hazards of medication followed a rotten apple script. Find patients with a problem, find the documents that a drug company knew about the problem in private but denied it in public, mention the ghost-writing that concealed the problem and lack of access to trial data, perhaps using a clinician or an ‘insider’ to provide dramatic focus and expose the company to media or legal questioning. The sight of a rotten apple being thrown out of the barrel reassured the public that healthcare was now more ethical than before, and gave bioethicists a case example to use in teaching (1). But what if we have a whole rotten barrel as outlined in this case study? What are the ethics then?

Caracterización de las atenciones de la unidad de psiquiatría de enlace durante seis meses en un hospital general de Lima, Perú / Analysis of the Care Provided Over a Six-Month Period by the Liaison Psychiatry Unit at a General Hospital in Lima, Peru

Resumen Introducción: La psiquiatría de interconsulta y enlace es un área de la psiquiatría clínica cuya función es que psiquiatras lleven a cabo una serie de actividades dentro de un hospital general. En el contexto internacional, el número de unidades de psiquiatría de enlace se ha incrementado significativamente, situación que está repercutiendo en Perú. Sin embargo, este desarrollo es heterogéneo y desconocido, por lo que se requieren reportes de estudios recientes que revelen las características y los detalles de los servicios de atención clínica de estas unidades. Objetivo: Examinar y reportar las características sociodemográficas y clínicas de los pacientes evaluados en la Unidad de Psiquiatría de Enlace del Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) de Lima, Perú, y analizar la naturaleza de los cuadros sintomáticos y sindrómicos presentes. Métodos: Estudio descriptivo y transversal de las interconsultas recibidas por la Unidad de Psiquiatría de Enlace del HNGAI entre mayo y octubre de 2019; se aplicó un análisis factorial de los síntomas. Resultados: En el total de 400 pacientes vistos en interconsulta, la media de edad fue 58 ± 17,09 arios. El 61,5% eran mujeres. La tasa de derivación fue del 2,73%. El servicio con el mayor número de referencias fue Medicina Interna (13,9%). Los trastornos más frecuentes fueron de naturaleza ansiosa (44%); los síntomas más frecuentes fueron ánimo depresivo (45,3%), insomnio (44,5%) y afecto ansioso (41,3%). Con respecto al tratamiento, el más prescrito fue con antidepresivos (44,3%). El análisis factorial exploratorio de los síntomas mostró 3 factores o componentes sindrómicos importantes: delirio, depresión y ansiedad. Conclusiones: El paciente típico de esta muestra es una mujer al final de su quinta década de vida, con enfermedad médica no psiquiátrica y con evidencia de trastornos ansiosos como diagnóstico principal resultante de la interconsulta psiquiátrica.

ABSTRACT Introduction Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. Aim To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyze the symptomatic and syndromic nature of the identified conditions. Methods Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. Results In a total of 400 referrals evaluated, the average age was 58 ± 17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. Conclusions: The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.

Evaluación inicial del Sistema de Referencia y Contrarreferencia ambulatoria en la DIRIS Lima Norte, desde los centros materno infantiles

Desde julio 2018 se implementa el SRCR de consulta ambulatoria en IPRESS de DIRIS Lima-Norte utilizando el aplicativo REFCON; incluye cinco sub-procesos, tres de ellos ocurren en IPRESS de destino. Objetivo : Caracterizar las referencias emitidas en las IPRESS I-4 que tuvieron como IPRESS de destino a los hospitales de la DIRIS Lima Norte, y el tiempo de citas de las mismas. Material y métodos : Estudio cuantitativo observacional de tipo transversal, que incluyó las referencias emitidas en el periodo mayo-octubre 2019, por siete IPRESS I-4. Se analizaron las referencias por IPRESS, sexo, etapa de vida, especialidad y tiempos hasta la cita. Se estimó medidas de tendencia central y dispersión; y chi-cuadrado para el análisis bivariado, usando Stata v.16. Resultados : Hubo 19 951 referencias de siete IPRESS de origen. La población más referida fue de 30-59 años (39,22%) y mujeres (67,04%). Se excluyó del análisis de tiempos 2 714 referencias por información incompleta. El tiempo de aceptación en IPRESS de destino mostró gran variabilidad, solo 23,14% fueron aceptadas en menos de 24 horas. El subproceso de aceptación hasta la cita mostró que la mitad de pacientes demoraron entre 80-85 días en ser atendidos. Solo se reportaron 110 contrarreferencias; de ellas, 48 (43,6%) fueron a Juan Pablo II. Conclusiones : Se evidencia una incipiente implementación, ausencia de normatividad, irregular capacitación de personal y limitación de personal que se traduce en alto porcentaje de rechazos y retrasos en aprobación de referencias. Y tiempos mayores de 80 días desde el registro de la referencia hasta la cita, para el 50% de las mismas, desconociendo el porcentaje de citas atendidas.

SUMMARY Starting in July 2018 the ORCR was implemented in the IPRESS-DIRIS Lima Norte using the REFCON instrument that includes five processes, three of which occur in the IPRESS of destiny. Objective : To characterize the references of IPRESS I-4 whose destiny were DIRIS Lima Norte and time to appointment of the encounters. Methods : A cross- sectional study was carried-out from May to October 2019 including seven IPRESS I-4. References by age, sex and specialty were analyzed as well as time to appointment. Statistics for means and proportions were calculated using Stata v.16. Results : A total of 19,951 references from seven IPRESS were included in the analysis. The most common age group was 30-59 years (39.22%): women accounted for 67.04%. We excluded from the final analysis 2,714 references for not having information on time to appointment. Only 23.14% of referrals were accepted in less than 24 hours. Half of patients had to wait between 80-85 days to have an appointment. Only 110 counter-references were reported, 43.6% went to Juan Pablo II. Conclusions : We observed a clearly inefficient system with long delays in making appointments and high rate of referral rejections, these findings are the result of lack of regulation, lack of manpower and poor training of the existing personnel.

Obstetric Referrals to a Tertiary Hospital in Northern Uganda- A One Year Experience

Delay in referral adversely affects maternal and neonatal outcome. We wanted to review the obstetric referrals, source of referrals, appropriateness of referrals and document the maternal and perinatal outcomes in a tertiary hospital in northern Uganda. MethodsThis is a secondary data analysis from case records. A descriptive study of 780 eligible obstetric referrals, with ≥28 week’s gestation, referred to the hospital for a period of 12 months were analysed with SPSS version 23. ResultsObstetric referrals accounted for 16.3% (780/4799) of the total admissions in 2018, 43.8% were from CEMNOC sites and 32.3% from HC IVs, while 57% from without Lira District, showing lacunae in the emergency obstetric care given at the HC IV levels and the districts hospital in the region. Majority or 93.5% (729) were intrapartum admissions and 98.1% (715) of these had labour outcome recorded, showing the nature of referrals. Most common diagnosis at referral was labour or complications of labour and only 4.6% had other diagnoses. The diagnoses at the time of admission were normal labour (31.0%); obstructed labour (25.1%); prolonged labour (7.1%). About 29.9% presented with more than one medical/obstetric complications, and the most common one was obstructed labour, preeclampsia, IUFD and previous caesarean section scars. The outcome of the referred cases included 45.1% (327) vaginal delivery (either spontaneous or augmented), 54.4% (396) caesarean section, 0.5% (4) Caesarean hysterectomy, 3.1% (24) transferred out undelivered, 1.2% (09) missing outcome while the 3.6% (28) with medical conditions were managed and discharged. There were ten (10) maternal deaths among the referrals, during the study period and 3 were due to obstetric haemorrhage; and behind these there were many near misses which would provide valuable information on the quality of care at the peripheral facilities. 80.4% (627) were live babies, 10.5% (82) were FSB/MSB and 10% had APGAR score ≤5 at 5 minutes of birth while 13.2% were of low birth weight. ConclusionsA wide spectrum of complicated and uncomplicated obstetric cases was referred to this hospital and majority were unjustifiable as majority of the referred conditions could be managed at the lower CEMONC sites. Unavailability of Comprehensive Emergency Obstetric Care (CEMONC) was the most common reason for referrals, even where infrastructure and human resource where known to be available. Most common diagnosis at the time of referral was prolonged/obstructed labour. Even today, obstetric haemorrhage is the leading cause of maternal mortality while prolonged/obstructed labour contributed to the high neonatal mortality.

Emergency obstetric care among referrals in more than 24 weeks gestation at a tertiary care teaching institution in Kerala, India

Background: One of the biggest barriers confronting efforts to reduce maternal mortality through increased skilled delivery is access to emergency obstetric care. This study aimed to look into the profile of emergency obstetric referrals. Referral-decision interval, reasons and morbidities of referral were analysed and their neonatal outcomes assessed.Methods: This observational study reviewed 90 emergency obstetric referrals over 3 years from June 2013 to February 2016.Results: In-labour referrals constituted the majority of emergency obstetric referrals. Preterm obstetric referrals needed emergency interventions in view of medical/obstetric indications and it was statistically significant. Referral- decision and referral-arrival interval was significant in emergency group (p-value-0.001). Babies born to mothers who were obstetric emergency referrals had extended NICU stay (p-value-0.001). There was a maternal death and four near-misses in this research.Conclusions: Timely decisions taken during interhospital emergency referrals resulted in better perinatal outcomes by prompt maternal interventions.

Study of cross-referrals to the dermatology department in an inpatient setting at a tertiary care centre

Background: Till recently, dermatology was primarily being considered to be an outpatient focused discipline. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. This study was conducted to analyse the incidence and indications for inpatient dermatology referrals and the impact of dermatology consultation on patient management.Methods: A cross-sectional study was undertaken by analyzing the records of 243 patients referred to dermatology department over a 2-year period. Descriptive analysis was conducted in the form of study of presumptive diagnoses by the referring clinicians, causes of referral, distribution of referrals across specialties and the dermatological opinions with respect to diagnosis and management etc.Results: Clinically significant change was documented in the course of skin lesions management of almost two-thirds of referred patients. Maximum referrals were from the department of general medicine with “skin rash” being the most common cause for seeking 2nd opinion. Concordance for diagnosis between the referring clinician and the dermatologist was observed in only 30.2% of the cases.Conclusions: Dermatologic referral does lead to improved patient care. But there is need for better training of non-dermatologists enabling them to recognize and treat common skin lesions.

Region wise referrals to a tertiary care centre: a retrospective analysis

Background: Emergency obstetric care in health care requires a linked referral system to be effective in reducing maternal morbidity and mortality. This review is aimed at summarizing the proportion of referrals from urban, rural and tribal areas of surrounding districts to tertiary care centre, King George Hospital, Visakhapatnam for a 6 month period; from May 2018 to October 2018.Methods: Retrospective study done at a tertiary care teaching hospital, including 3157 cases referred from the surrounding urban, rural and tribal areas.Results: Out of the 3157 referred cases, most of them (1658) were from rural areas, 1030 from urban and 469 from tribal areas. Referrals done in view of post caesarean pregnancies were more in urban and rural areas whereas more preeclampsia and anaemia cases were referred from tribal areas. Various indications of referral are documented. Majority of them were unbooked cases.Conclusions: Specific guidelines regarding whom to refer, how to refer and when to refer would be helpful in making timely referral. These would also help to decrease the burden on the tertiary care centers which deal with a huge caseloads in spite of limited infrastructure and manpower. Adequate attention and better care can be given to complicated cases if the total case load is reduced. Stringent documentation in referral slip and better co-ordination are required for a strong health care system.

Analysing maternal determinants and characteristics of obstetric referrals at a tertiary care centre in Kerala, India

Background: Timely and prompt referral of high risk pregnancies is an integral part of emergency obstetric care and is one of the effective strategies to avoid adverse pregnancy outcomes. This study aims to assess the maternal determinants and characteristics of obstetric referrals to Travancore Medical College and Hospital.Methods: This observational study reviewed 124 obstetric referrals over 3 years. Maternal risk factors and sources of referral were looked into. Distance travelled, referral-arrival interval, mode of transport, gestational age at referral, medical co-morbidities necessitating emergency/elective transfers to this tertiary centre have been analysed.Results: Referral rate was 7.03%. Mean age was 26. Primipara and multipara went hand in hand. 95% were graduates. Materno-fetal (58%) contributed the bulk of obstetric referrals. 83.1% were from private hospitals and 64 were in-labour referrals. 71.6% had referral arrival distance of <15 kms. Mode of transport used by the referred patients was by ambulances (73.9%). Around 48% of our population had GA of 33-36.6 weeks. 73% had emergency decision among which caesarean was 83%. Anaemia (34%), HDP (30.5%), GDM (14.2%) and hypothyroidism (17.7%) were medical co-morbidities necessitating referrals. There was 1 maternal death and 4 near miss mortality cases. Mean hospital stay in private sector referrals was 10.17 days and it was 7.62 days in government referrals.Conclusions: Timely referrals with detailed referral slips imparting information regarding treatment received at the referring hospital has helped in early and optimal intervention in the study.

Patterns of Referral to Clinical Psychology Services in the Ministry of Health Malaysia

@#Background: This descriptive study identifies the demographic characteristics and patterns of referral to clinical psychology services, which include types of diagnosis, types of referral and source of referrals in child, adolescent, adult and geriatric cases in Malaysia. Methods: We utilised 2,179 referrals between January and December 2015 from six general hospitals and three mental health institutions that provide clinical psychology services. Results: The percentage of male referrals (60.3%) is higher than that of female referrals (39.7%). Adult cases had the highest percentage of referrals (48.2%). Children (48.8%) and adolescent (28.1%) cases were mainly referred for psychological assessment. Meanwhile, adult cases (74.8%) were mainly referred for psychological intervention. Neurodevelopmental disorders was the diagnosis with the highest percentage of referrals recorded (41.4%), followed by depressive disorders (13.3%) and anxiety disorders (12.7%), and the combination of other disorders. Psychiatrists provided the highest number of referrals (82.2%), which is unsurprising as both fields are closely related. Conclusion: Clinical psychology services within the Ministry of Health (MOH) Malaysia play an important role in mental health care.

Patterns Of Psychiatric Referrals In Tertiary Care Hospital: An Overview Of Consultation Liaison Psychiatry.

Background&Objective:To study the patterns of psychiatric referrals in a newly established tertiary care teaching Hospital has been important for understanding consultation liaison psychiatry and setting up better general hospital psychiatric units. The aim of the present study was to study referral characteristics’ of patients of various departments to psychiatric unit at a tertiary care teaching hospital.Methodology:All referrals made to psychiatry department over a period of one year were assessed by psychiatrist based on structured performa including demographic data, referring department, referral note, present complaints, past history of psychiatric illness, family history of psychiatric illness, mental status examination and DSM –IV-TR criteria to diagnose psychiatric illness and analyzed.Results:Out of 400 referred patients to psychiatry unit over a period of one year, majority were from Medicine department (62.75%). Substance use disorder (37.25%) was the most common diagnosis followed by depressive disorders (15.75%) and anxiety disorders (8.25%). 235 (58.75%) references were with statement like ‘psychiatry reference’ and no reason mentioned for that. Significantly higher proportions of OPD referrals (71.81%) were made with statement like ‘psychiatry reference’ and no reason mentioned for that as compared IPD referrals (41.62%). Significantly higher proportions of patients (66.75%) with past history of psychiatric illness were referred with statement like ‘psychiatry reference’ and no reason mentioned for that as compared to patients (52.81%) without past history of psychiatric illness. Conclusion:Study highlights importance of consultation-liaison psychiatry through referral pattern in a tertiary care teaching hospital. More referrals for Substance use disorders suggest emerging need to develop separate deaddiction services in our setting. Past history of psychiatric illness was considered significant factor for referrals from other departments and majority of references were without any details. There is need to sensitize other specialists, especially general physicians who are the common source of referrals regarding common psychiatric conditions and proper referral note to improve consultation liaison psychiatry in general hospital setup.

A comparative study on the reasons for non-compliance to outpatient charity appointments of child and adult patients seen as emergency referrals to the Department of Psychiatry and Behavioral Medicine of the UP-Philippine General Hospital from June 1-August 31,2013

OBJECTIVES: This study aims to identify the rate of noncompliance and the reasons for noncompliance to outpatient appointment among child and adult patients who were initially seen as emergency psychiatric referrals from June 1 to August 31,2013 at the UP-Philippine General Hospital.METHODOLOGY: This is a descriptive study. Total enumerative sampling of all patients seen as emergency psychiatric referrals was done. Results included percentage of noncompliance to appointments and a comparison of the rates using z-test. Top reasons for noncompliance were identified based on frequency and percentage. Comparison of reasons between child and adult groups was done using Fisher's exact test.RESULTS: Majority (71.3%) of patients who were seen as emergency referrals to the Section of Psychiatry and Behavioral Medicine during the study period was non-compliant with their outpatient follow-up appointments. There was no statistically significant difference between child and adult groups in terms of rate of compliance and reasons for non-compliance.CONCLUSION: The most common reasons for non-compliance to outpatient charity appointments: were unclear instructions about follow-up date and procedure;conflict with work or school schedule; perceived recovery after initial consult; no available companion; and no budget for transportation.

Attitude and motivation factors towards volunteering for HIV/AIDS care work in Southern Nigeria.

Background: The use of volunteers in task shifting has helped in improving access to comprehensive HIV care in a challenging era of staff attrition, work overload and complex referral system. Aims & Objective: The aims and objective of this study is to assess attitude and motivation factors for volunteering work in HIV care programme work in Southwestern Nigeria. Material and Methods: This was a Descriptive cross sectional health facility based study carried out among eligible volunteers in Southwestern states in Nigeria. Ninety six (96) health facility based volunteers in Southwestern Nigeria, using multistage sampling technique. Research instruments employed were semi structured; self-administered pre tested questionnaires administered on eligible volunteers. Data was analyzed using the SPSS software version 13.0. Data was presented in form of frequency tables, while association between categorical variable was determined at a significance level of P<0.05. Results: The mean age of respondents was 33.8 (±1.6) years, while 72 (75.0%) were members of HIV support group. Fifty six (58.3%) had formal training on HIV care before commencement of volunteering work. Sixty two (86.1% of support group members and 64.5% of total respondents) would like to encourage other support group members to take up volunteering work. Common motivators for volunteer job include the desire to know more about HIV 88 (91.7%), to assist the community 81 (84.4%), to assist fellow HIV positive clients 64 (66.7%) and to relieve health care workers of work overload 84 (87.5%). Thirteen (13.5%) has ever dropped out of volunteer work before. Respondents felt they could assist to reduce stigma and discrimination, give counselling and information to HIV clients and completion of referrals. Perceived challenges to volunteering work include poor training in 73 (76.0%), poor supervision by skilled health workers 68 (70.8%), poor referral feedback 65 (67.7%) and complex referral forms and tools being used 64 (66.7%). There is a significant association between receiving formal training on HIV care and willingness to encourage other support group members towards volunteering for HIV care work (N = 42, χ2 = 3.142, p=0.003). Conclusion: Majority of volunteers were HIV peers. Empathy, human feelings and interest motivated most volunteers under study. Periodic trainings and supervision could serve as viable means of encouraging them towards a productive volunteering work.

Análisis de la referencia de pacientes a un hospital de tercer nivel pediátrico / Analysis of patients referred to a pediatric third-level hospital

Análisis descriptivo de las referencias de pacientes que llegan al Hospital del Niño "Dr. Ovidio Aliaga Uria", tomando en cuenta la red de referencia, el nivel de atención del que fue referido, justificación de referencias, calidad de las mismas, diagnóstico dado, tratamiento indicado, coordinación y la necesidad de internación de estos pacientes. Resultados: Entre julio y septiembre de 2012, se realizaron 300 referencias, 51% fueron justificadas, y 49% injustificadas. Según el nivel de atención, el 1er nivel fue el que tuvo más referencias injustificadas, seguido del 3er nivel y luego del 2do nivel. El 1er tuvo la mayor cantidad de referencias de mala calidad, con manejos errados, trasladados sin personal médico ni ambulancia, independientemente del estado del paciente, referidos directamente al tercer nivel sin coordinación previa, saltando al segundo nivel.

Descriptive analysis of patient referral to Children's Hospital "Dr. OvidioAliaga Uria": network of health facilities and level, justification, their quality, treatment, coordination and the need of hospitalization were revisited. Results: between july and September of 2012, 300 referrals were realized, 51% justified and 49% were unjustified. The 1st level had more unjustified references, followed the third level. The 1st level had the highest number of poor quality references, with wrong treatments, without medical or ambulance regardless of patient condition, referred directly to the third level without coordination, bypassing the second level.

Incidence of Mood Disorders among Referred Indoor Patients.

Consultation-Liaison (C-L) Psychiatry is a growing area of research in psychiatry where a large number of patients having main complaints of psychiatric symptoms in the non-psychiatric wards. So diagnosis of these cases fully depends upon referrals. In spite of the high prevalence of Psychiatric morbidities in India, the overall referral rate was 1.48 %(4) .This study is aimed to find out the incidence of mood disorders among referred indoor patients from Medicine & allied departments of Medical College, Kolkata. The study was done using psychiatric referrals from General medicine and allied department. The study may sensitize all medical professionals and it will contribute towards improvements of mental health at all levels of health care institutions.

A Study of Psychiatric Referrals in a Multidisciplinary Teaching Hospital.

Between April 2009 and June 2009, a three month period, a total of 130 inpatients from a tertiary care, multidisciplinary hospital were referred for psychiatric opinion. 35 cases were referred for attempted suicide and 95 cases for other reasons. An analysis of these two groups of referrals was done to study the referral trends. About 7% with organic disorders, 14.6% presented with drug dependence, 7.7% with schizophrenia and psychotic disorders, 22.3% presented with mood disorders. Our findings were like other Asian countries with a significant group comprising of dissociative disorder (hysteria) unlike west.

Treatment Process and Outcomes of Brain Injuried ER Patients / 예방의학회지

Injuries and infectious diseases have been the most important public health problems since the beginning of human life. Injuries result in death of about 30,000 people each year in South Korea. In terms of years of life lost, injuries are considerably more costly than either heart disease or cancer. In terms of cost - both the direct costs of care and the indirect costs to individuals, families, and societies of a diminished life - injuries are among the most expensive of all social problems. The main purposes of this study are (1) to describe the outcomes as well as treatment process of brain injured patients and (2) to identify the factors impacting on length of stay during hospitalization and hospital fees. The research method used in this study was to review the medical records of five hundreds brain injured cases using systemic random sampling. The multiple logistic regression was administered to identify the factors impacting on the outcomes. The results are as follow: (1) the consultation rate was found to be 72.9% while referral rate was 11.2%; (2) nearly 30% of the respondents were hospitalized over 30 days; (3) multiple logistic regression analyses revealed that the determinants influencing LOS were number of consultations, number of lab tests, and surgery; (4) the determinants of hospital fee were severity of brain injury, gender of patients, number of consultations, number of lab tests, and surgery.