Pattern of referral and hospital feedback in family practice centers Ismailia-Egypt

Referral rate varies widely, even among family physicians within the same practice. No body can deny the increasing cost of the health care. Health care costs are tried to be cut by family physicians/general practitioners. This could be achieved partly by treating patients on an ambulatory care basis rather than hospitalizing them through appropriate shared consultation with other specialties in addition to rational use of available resources through use of the referral system appropriately. The present study aimed at identifying the rate of referral and hospital feedback at family practice centers affiliated to faculty of medicine-Suez Canal University [FOM-SCU] an that belonging to Ministry of Health and Population [MOHP]. Also, the quality of referral letters was assessed. This study was conducted in four family practice centers in EL Mahsama and Abou Khalifa villages in Ismailia Governorate, two centers belonging to the Faculty of Medicine of Suez Canal University, while the other two centers belonging to Ministry of Health and Population. Over a period of 6 months, the medical records in these centers were examined to identify the total number of patients attending these health facilities through reviewing the daily sheet of the clinics. Over the period of study a duplicate forms of the referral letter with hospital feedback were dept in the family practice centers in the referral register. Data obtained from medical records were evaluated to identify rate of referral and hospital feedback. The quality of referral letter was evaluated for the presence or absence of predetermined items for both identification and clinical data that recommended by WHO. Results showed that, the rate of referral from these family practice centers is low compared to other studies [2.27%] also, there was statistically significant difference in referral rate between family practice centers of FOM-SCU and MOHP [X2 =4.02, p<0.05]. it was found that, although the referral rate among qualified physicians [2%] was lower than noon-qualified physicians [2.3%], there was no significant difference [X=0.94, p=0.3324]. referral for further investigations and unavailable treatment modalities came at the top of reasons for referral with rate of 34.29% and 26.81% respectively. Referral for shared consultation represented only 15.38%. surgery, laboratory and obstetric and gynecology departments come at the top of the list [20.44%, 16.7% and 14.72% respectively. The study revealed the absence of adequate, efficient hospital feedback and the connection between the family physicians in family practice centers and specialists in hospitals is nearly lost [very low rate of hospital feedback [0.8%]]. It was found that 47.4% of referral letters were poor [score <13 items]. Understanding and awareness among primary health care physicians [PHCs] and specialists regarding the organization of the referral system is needed to deliver a better health are to the patients. This study highlighted some of the inadequacies that may hinder the effectiveness of the referral system in the family practice centers as the absence of feedback report by the hospital to which these patients are referred. Such problems will affect the continuity of care of patients negatively and may result in lack of patient satisfaction. In addition, lack of facilities in family practice centers make the highest referral rate by the physicians is for doing laboratory investigation to reach the final diagnosis

Methanol induced retinal and hepatic toxicity in the rat model and role of antioxidants

Human methanol poisoning is characterized by serious visual impairment, hepatic toxicity and formic acidemia. Non-primate species are resistant to the accumulation of formate and the associated methanol toxicity. A non-primate model of methanol induced toxicity was developed using adult albino rats treated with subanaesthetic concentrations of nitrous oxide to inhibit the oxidation of methanol's toxic metabolites. Methanol intoxicated rats developed retinal and hcpatic toxicity as well as metabolic acidosis analogous to methanol toxicity in humans. This work was conducted on 140 adult albino rats divided into 5 groups. The first group [control group] was further subdivided into 6 subgroups each consisted of 10 rats. The other 4 groups consisted of 20 rats each. Group Ia was the negative control group, group lb received 2 mL normal saline orally, group Ic was exposed to a mixture of N20: 02 [1:1 flow rate 3 liters/min] for 4 hours, group Id was given methyl alcohol orally in a dose of 4 g/kg followed by further 2 doses [2 g/kg] at 12 and 24 hours after the initial dose, group Ie was given N-acetyl cysteine orally in a dose of 100 mg/kg 30 mill and repeated every 8 hours for further 3 doses, and group If was given melatonin orally in a dose of 30 mg/kg 30 min and repeated every 8 hours for further 3 doses. Group II was exposed to N20: 02 mixture for 4 hours followed by methanol administration orally in a dose of 4 g/kg followed by further 2 doses [2 g/kg] at 12 and 24 hours after the initial dose. Group III was exposed to the mixture of N20: 02 for 4 hours then was given methyl alcohol as in group II then N-acetyl cysteine as mentioned before. Group IV was exposed to the mixture of N20: 02 for 4 hours then was given methyl alcohol as in group 11 then melatonin as mentioned before. Group V was exposed to the mixture of N20: O2 for 4 hours then was given methyl alcohol as in group 11 then N-acetyl cysteine and melatonin together in the same doses and timing as groups III and IV. At the end of the experimental period, the animals were anaesthetized for fundus examination. Then the animals were sacrificed, blood samples were withdrawn for measuring arterial blood gases and malondialdehyde [MDA], the eyeballs and livers were taken for histopathological study. The biochemical results revealed highly significant changes in pH, bicarbonate and malondialdehye concentrations in methanol intoxicated rats [group II]. On administration of N-acetyl cysteine or melatonin after methanol intoxication, there was significant decrease in lipid peroxidation products [MDA] especially with melatonin but the pH changes were not improved. As regard to ocular examination there was a significant improvement in optic disc and retinal edema especially when melatonin and N-acetyl cysteine were given together. Histopathological results of the liver and retina revealed an improvement with either N-acetyl cysteine or melatonin, however, melatonin was more protective. The combination of both antioxidants gave the best results. From the results of this study, It can be concluded that melatonin and/or N-acetyl cysteine have protective effects against methanol-induced ocular and hepatic toxicity