General practitioner referral guidelines for dermatology: do they improve the quality of referrals?

Guidelines have proliferated in recent years in all areas of medicine, sometimes with little evaluation of their effect. Referral guidelines for dermatology were compiled by the dermatologist at the Royal Surrey County Hospital in consultation with local general practitioners. An audit was undertaken to assess how appropriate referrals were just before and after distribution of the guidelines and was repeated 2 years later to determine whether they had made any significant impact. The results revealed a 40% increase in the number of appropriate referrals immediately after introduction of the guidelines, but this was not sustained 2 years later. Five common conditions accounted for two-thirds of inappropriate referrals before and after the guidelines were sent. The need for continued general practitioner education in dermatology to reinforce referral guidelines is demonstrated.

Evaluation of the first international teleconference in ophthalmology.

The First International Teleconference in Ophthalmology was held during March 1998 between five sites in the UK, USA, Greece and Malaysia. ISDN transmission at 128 kbit/s was used to reduce costs while maintaining the clarity of the presented material. Specialized lecture theatres were not available at all sites and conventional halls had to be adapted for videoconferencing. For this reason initial point-to-point testing was carried with Bristol to simplify problem solving. Thereafter, a multipoint bridge was used to connect all sites together. During the conference a number of individual presentations were given, all followed by extensive discussion periods. Special instructions were given beforehand on the production of slide material, with particular reference to font sizes and colour combinations. Full use was made of various presentation media, including slides, videos and live demonstrations. The conference was attended by over 500 delegates, all of whom were specialists in ophthalmology. The technology employed was ideal for teaching purposes. However, if used in a clinical field, it should be kept in mind that the choice of transmission rate makes certain features not easily apparent in images but they become clearer when pointed out by the presenter.

Interexaminer reliability of chiropractic evaluation for cervical spine problems--a pilot study. Part 1: Graduates from one institution.

OBJECTIVE: A pilot study was conducted to determine whether untrained examiners could agree on palpatory findings in the cervical spine. DESIGN: Fifty-three university students, (most of whom were chiropractic students), had their cervical spines examined by seven different chiropractors using their own clinical methods, of which motion palpation was a common, but not standard component. SETTING: Chiropractic Centre in Macquarie University. PARTICIPANTS: Volunteer university students. MAIN OUTCOME MEASURES: Individual clinical methods, which included static and/or motion palpation, vertebral springing, range of motion and applied kinesiology. RESULTS: Statistically, for the total group, there was poor interexaminer reliability. Of eight examiners, four did not disagree significantly, the next two examiners disagreed with each other but only at a single level and the remaining two examiners disagreed with most of the other examiners and each other. CONCLUSION: In the cervical spine, it appears that C6 is the level of highest contention, followed by C1 and C5. Essentially the results suggest that combinations of examiners show reasonable consistency at identifying the same entity while using their own typical examination techniques. The nature of these palpable findings, leading to a diagnosis of subluxation or vertebral dysfunction is ill defined. Several issues were considered as important: expectations of examiners, research design, subject compliance, role of asymptomatic subjects and what the examiners were actually detecting.