Despite ubiquitous use of medical imaging in daily medical practice, the quality of referrals varies significantly across a variety of practice types and locations. This systematic review summarises studies in the literature that have employed interventions aimed at improving radiology referrals, excluding clinical decision support software. A systematic review of literature was conducted in PubMed, EMBASE, Scopus, and Cochrane. Two reviewers independently identified studies for inclusion. All studies that included interventions with any outcome measure were included. Any irrelevant studies, non-English studies or not retrievable studies were excluded. Studies were grouped into Education, Feedback, Rationing, Penalties, and Other. The outcomes of the studies were summarised and qualitatively analysed due to anticipated heterogeneity. Four thousand six hundred and forty-two studies were identified throughout PubMed, EMBASE, Scopus, and Cochrane. One hundred and eighty-seven duplicates were removed and 4436 abstracts were screened. Two hundred and forty were identified on the first phase of the screening with 167 then excluded for non-relevancy. Seventy-five full studies were included in the final analysis following the addition of 2 additional studies. Fifty-seven studies were grouped into Education, 10 into Feedback, 4 into Rationing, 8 into Penalties, 9 into Other and 11 containing multiple. Eighty-four percent of the studies reported an improvement in the quality of the referrals. Despite a variable rate of quality referrals, there are many interventions that radiology departments across the world can utilise to improve the referral process.

UNASSIGNED: Waiting time of patients from a consult with a primary care physician to a specialist is poorly understood. It is one indicator of health service delivery and patient satisfaction. Patients consider waiting for a specialist consult for more than three months too long and unacceptable.
UNASSIGNED: To describe the sociodemographic and clinical factors associated with length of referral waiting time.
UNASSIGNED: Cross-sectional retrospective chart review of patient records in a tertiary government hospital from 2015 to 2019.
UNASSIGNED: A total of 366 charts were reviewed. Many of the patients referred to other specialty clinics were middle-aged adults and females. Median wait times for medical and surgical specialties were 11 (IQR: 0-29) and 18 (IQR: 6-35) days, respectively (p=0.003). Nutrition, rehabilitative medicine, and family health unit received the most number of referrals among non-surgical fields. Ophthalmology, otorhinolaryngology, and general surgery received the highest number of referrals among the surgical fields. Referral waiting times were longest for cardiology (median: 125, IQR: 91-275 days) and shortest for nutrition (median: 0, IQR: 0-6 days).
UNASSIGNED: Waiting times from a primary care clinic to a specialty clinic at a tertiary government hospital vary based on urgency, specialty clinic, purpose of referral, presence of comorbidities, and chronicity of condition. Clinical factors found to be significantly associated with referral waiting time include urgency, type of clinic, and purpose of referral.

UNASSIGNED: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients\' clinical problems more effectively and risk stratify the patient.
UNASSIGNED: The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms.
UNASSIGNED: There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings.
UNASSIGNED: Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician\'s decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign.

UNASSIGNED: Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted.
UNASSIGNED: This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families.
UNASSIGNED: Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.

We aimed to (1) identify existing triage approaches for referral of patients with suspected inflammatory arthritis (IA) from primary care physicians (PCP) to rheumatologists, (2) describe their characteristics and methodologies for clinical use, and (3) report their level of validation for use in a publicly funded healthcare system. The comprehensive search strategy of multiple databases up to October 2023 identified relevant literature and focussed on approaches applied at the PCP-Rheumatologist referral stage. Primary, quantitative studies, reported in English were included. Triage approaches were grouped into patient conditions as defined by the authors of the reports, including IA, its subtypes and combinations. 13952 records were identified, 425 full text reviewed and 55 reports of 53 unique studies were included. Heterogeneity in disease nomenclature and study sample pretest probability was found. The number of published studies rapidly increased after 2012. Studies were mostly from Europe and North America, in IA and Axial Spondyloarthritis (AxSpa). We found tools ranging the continuum of development with those best performing, indicated by the area under the receiver operating curve (AUC) >0.8), requiring only patient-reported questions. There were AUCs for some tools reported from multiple studies, these were in the outstanding to excellent range for the Early IA Questionnaire (EIAQ) (0.88 to 0.92), acceptable for the Case Finding AxSpa (CaFaSpa) (0.70 to 0.75), and poor to outstanding for the Psoriasis Epidemiology Screening Tool (PEST) (0.61 to 0.91). Given the clinical urgency to improve rheumatology referrals and considering the good.

UNASSIGNED: Rehabilitation can positively affect quality of life, functional status, and physiological status for patients with head and neck or lung cancer. However, barriers and facilitators regarding access, referral, and participation in rehabilitation have not been outlined in the literature either from a healthcare professional or from a structural perspective. Therefore, the objective of this paper was to identify and map barriers and facilitators from structural and healthcare professionals\' perspectives in relation to access, referral, and participation in rehabilitation for patients with head and neck or lung cancer.
UNASSIGNED: Two systematic searches were conducted in five databases mapping peer-reviewed research literature.
UNASSIGNED: In total, 17 studies of 3918 potential sources were included. Seven themes were identified. Four themes concerned access: Understanding Patients\' Resources; Collaboration Determining Access; Education, Knowledge, and Evidence Impact Access to Rehabilitation; and Resources Affecting Availability to Rehabilitation Services. Two themes concerned referral: Referral Criteria; and Elements Affecting Referral Pathway. One theme concerned participation: Factors Influencing Participation.
UNASSIGNED: From structural and healthcare professionals\' perspectives, barriers and facilitators impact access, referral and participation in rehabilitation. However, the findings on facilitators were limited; only one theme addressed participation and two findings concerned patients with low socioeconomic status.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be mindful that a diverse array of barriers and facilitators may impact the rehabilitation pathway for patients with head, neck, and lung cancer.Engagement by healthcare professionals and structural initiatives are needed to ensure comprehensive access to information concerning rehabilitation options.Local guidelines should be developed to prescribe methods for informing and guiding patients towards suitable rehabilitation options.It is important that healthcare professionals take the individual patient\'s resources into account when navigating aspects of access, referral, and participation in rehabilitation.

UNASSIGNED: Recent advances in telemedicine have led to increased use of digital ophthalmoscopes (DO) in clinical settings. This review aims to assess commercially available DOs, including smartphone (SP), desktop, and handheld ophthalmoscopes, and evaluate their applications.
UNASSIGNED: A literature review was performed by searching PubMed (pubmed.ncbi.nlm.nih.gov), Web of Science (webofknowledge.com), and Science Direct (sciencedirect.com). All English-language papers that resulted from the search terms \"digital ophthalmoscope\", \"screening tool\", \"glaucoma screening\", \"diabetic retinopathy screening\", \"cataract screening\", and \"papilledema screening\" were reviewed. Studies that contained randomized clinical trials with human participants between January 2010 and December 2020 were included. The Risk of Bias in Systematic Reviews (ROBIS) tool was used to assess the methodological quality of each included paper.
UNASSIGNED: Of the 1307 studies identified, 35 met inclusion and exclusion criteria. The ROBIS tool determined that 29/35 studies (82.8%) had a low risk of bias, 3/35 (8.5%) had a moderate risk of bias, and 3/35 (8.5%) had a high risk of bias.
UNASSIGNED: The continued adoption of DOs remains uncertain because of concerns about the image quality for non-mydriatic eyes and the confidence in data captured from the device. Likewise, there is a lack of guidelines for the use of DOs, which makes it difficult for providers to determine the best device for their practice and to ensure appropriate use. Even so, DOs continue to gain acceptance as technology and practice integration improve, especially in underserved areas with limited access to ophthalmologists.

Referral in the health system is a systematic process for the optimal allocation of resources and improves the access of people in need of treatment services. Considering the vulnerability of the veterans and more medical needs in this group, this study aims to identify the components that affect veterans\' health services referral system. MEDLINE, Scopus, Web of Science, and ProQuest databases, the international military studies website, and key journals in the field of veterans\' health services were searched with related keywords including \"veteran,\" \"referral system,\" and \"health services\" for the period from January 2000 to July 2022. Studies were screened and selected in accordance with the phases of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) flow diagram 2020. Data extraction was done by two researchers independently and a thematic content analysis method was used to analyze the findings. Among 40,608 studies searched electronically and 16 studies searched manually, 19 studies that met the inclusion criteria were selected. The research method applied here is a combination of quantitative, qualitative, and mixed methods. The most important findings were extracted from the included studies and analyzed in three general categories: components related to the patient, service provider, and the structural-operational mechanisms of the referral system. The effective performance of the referral system for providing health services to veterans is influenced by the factors affecting components related to the patient, the service provider, and the structural-operational mechanisms of the referral system. Evaluating and improving each of these factors improve the performance of the referral system and provision of health services to veterans.

Receipt of palliative care (PC) has long been suggested in practice for patients with advanced cancer for improved quality of life, mood, and prolonged survival. However, PC referrals in women with ovarian cancer remain suboptimal.
To consolidate existing literature on the multiple factors associated with PC referrals in women with advanced ovarian cancer and to better understand the contextual factors of PC referrals and frame receipt of PC using a socioecological model.
A search of scientific databases was conducted, including PubMed, Embase, CINAHL Complete, and PsycINFO. Key search terms included \"ovarian cancer\" and \"palliative care,\" and later refined to include advanced stages of the diagnosis. The reviewed articles included a focus on advanced ovarian cancer and reported demographic, medical/clinical, support, or system-level factors examined in the PC referral process.
Thirteen articles focused on the factors directly associated with PC referrals. Factors were categorized into different socioecological levels: tumor-level, intrapersonal, interpersonal, and environmental. Factors included tumor characteristics, age, marital status, medical condition, performance status, psychosocial status, support system, provider, and infrastructure. The patient\'s medical condition was the major component considered in PC referral and care transition.
Various factors in the socioecological framework suggest that the decision for PC referral could be multifactorial and influenced by factors beyond the medical condition and status. Future research should aim to understand the impact of various socioecological factors on PC referral and examine PC referral experiences from the patient\'s perspective.

UNASSIGNED: When a child with chronic gastrointestinal (GI) symptoms presents to a primary care physician or general paediatrician, the clinician is challenged with differentiating between functional or organic disease. When there is a high suspicion of inflammatory bowel disease (IBD), rapid referral to a paediatric gastroenterologist for assessment and treatment will help protect against the sequelae of a delayed diagnosis for a child. However, this must be balanced against the need for ensuring appropriate referrals and avoiding invasive diagnostic testing for those with non-organic aetiology. The objective of this narrative review was to present evidence on specific presenting symptoms, testing, and risk factors of paediatric IBD that may aid the identification of children requiring timely referral for specialist care, thereby reducing the chance of a delayed diagnosis.
UNASSIGNED: Literature databases (Medline, Embase) were searched using terms specific to the population studied, and topic specific terms relating to each section of the review. Year limits were set for 2010-2022. Included papers were limited to original research, with meta-analyses considered where of benefit.
UNASSIGNED: Children often present with non-specific GI symptoms that may be associated with a delayed diagnosis for those with subsequent IBD. Symptoms such as rectal bleeding or weight loss may indicate the need for rapid referral. However, non-specific symptoms necessitate testing strategies to differentiate between those with possible IBD and non-organic conditions. Definitive laboratory testing for IBD is not yet available. This review outlines those metrics that should be considered and monitored, then utilised to make a comprehensive referral to tertiary care for specialist paediatric gastroenterology review. Summaries are provided relating to presenting symptoms, extra-intestinal manifestations (EIMs), and alarm symptoms in order to highlight those reported most frequently. The diagnostic accuracy and importance of interpreting faecal calprotectin (FC) levels, in conjunction with additional measures, are also outlined.
UNASSIGNED: Diagnostic testing to effectively identify children with IBD without the need for endoscopy is not yet available. Primary care physicians and general paediatricians must, therefore, rely on interpreting a combination of symptoms, laboratory parameters, and risk factors to assess the need for specialist referral and diagnosis.