The clinical management of patients with CKD is based on a number of clinical guidelines (e.g. NICE, SIGN, and KDIGO), these cover the identification of CKD, referral criteria to nephrology services and guidance on the management of complications like renal bone disease and anaemia, with little focus on assessing and managing the risk of CKD progression [ 47, 155, 156].
The participants appreciated applicability in daily practice of knowledge aspects (item scores 3.3 3.8, five-point scale), but scores on self-reported identification of disease, referral to a specialist and knowledge about the possibilities/limitations of genetic testing were near neutral (2.7 2.8, five-point scale).
The consequences of this difficulty may be the lack of identification and referral of students who need clinical evaluation, as well as inappropriate referral of healthy students to mental health services.
The referral process consists of three parts: the identification of patients, the referral by the treating physician, and the decision of the patient.
Identification of sick newborn and referral: Referral suggested for convulsions, unconsciousness, breathing difficulty, the baby is hot or cold to the touch, weak or absent cry, lethargic or less-than-normal movement, inability to suckle, skin pustules or redness, umbilical redness extending to the skin, or yellow colouration of the body.
The guide covered the following main themes; (a) Awareness of childhood TB; (b) Identification and referral of suspected cases of childhood TB; (c) Tools and supportive structures; (d) Challenges and needs.
The Project had an important contribution to the promotion and realisation of children's rights by embedding them in revised legal framework and policy documents, improving the mechanism of identification, referral and redress of child rights violations.
Identification of children for referral to critical care experts remains problematic.
In-service training and increased support, both for cadres authorised to prescribe and administer ACS and for cadres involved in identification of risk and referral, are also critical to any scale-up effort.
It is hoped that a modified STOP-BANG with improved specificity, while not compromising sensitivity, may be developed that can be used safely in primary care for identification of patients requiring referral to sleep services.
