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The art of the air contrast barium enema is rapidly fading because of referral patterns and lack of interest.
The hazard ratios for renal impairment, however, were significantly elevated among participants with incomplete follow-up, possibly because of referral to specialist care after diagnosis of renal impairment.
Some conditions will be overrepresented because of referral bias and because certain tests (e.g., for H. pylori) were performed as diagnostic evaluation of symptomatic patients.
In the PregMet study, pregnant women were recruited from gynaecological outpatient clinics, fertility clinics, private practice and because of referral to an ultrasound early in pregnancy.
Another source of bias may be the fact that the study occurred in a national referral hospital, where the patients may have been more complicated because of referral patterns.
In the interview group, 148 (89.7%) participants completed all three screenings and 17 withdrew because of: referral to university hospitals (n = 3); moving out of the area (n = 9); preterm delivery (n = 1) or refusal to continue the screening interview (n = 2).
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Facility-based MMR are generally higher than community-based estimates because of referrals to these structures of more severe cases.
Therefore, more severe or complex diseases may be overrepresented because of referrals to specialized GeoSentinel clinics, along with an underrepresentation of mild or self-limited conditions normally seen at nonspecialized primary care practices.
Because sources of referral include health professionals, schools, social services, and parents themselves, the group of children scheduled for first appointment is heterogeneous in terms of psychopathology, including children without disorders and clinical cases of different severity levels.
Those misdiagnoses do not amount to any loss of chance because the timing of referral to ophthalmologists for further management remains the same as per recommendations (4, 5).
Some health workers are not aware of the need to refer patients, or if they do, patients don't want to go and disclose their positive status in other hospitals, or may not go even because of lack of referral forms".
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com