Accepting the limitations of research using 'paper-case' scenarios and reported behaviours, the study did find a pattern of under-referral and/or late-referral for advanced renal failure.
There is evidence however that there may be a pattern of restricted referral to Nephrologists from medical practitioners caring for the elderly [ 10, 11].
In order to assess if there had been a change in this pattern of referral during the period of the study, we compared the referral sources of this group of asymptomatic women (with a positive family history of breast cancer) before and during the trial.
We studied the pattern of referral of inpatients from secondary care hospitals to a tertiary care university hospital and the reverse referral under the situations using a geographic information system (GIS), taking paediatric inpatients as an example.
The second development involved changing the pattern of referral while maintaining patient safety.
We studied the pattern of referral form secondary care to tertiary care university hospital and the reverse referral in Japan, taking paediatric inpatients as an example.
Where available, second-line ART was almost always LPV/r and the pattern of referral was similar to adults.
We also found that sex was not associated with likelihood of timely referral and no clear pattern of referral was found by age.
For example, the usual pattern of referral in Malawi is from local health center, to district hospital, and, if needed, from the district hospital to the central hospital.
The classic pattern of referral to specialists as the major therapeutic option is often not relevant since it does not readily occur in day-to-day practice.
