Medical Specialty Referrals from a Student Health Service

Abstract

During a 10-week period, 51 referrals resulted from 3171 visits to the Student Health Service, a referral rate of 1.6%. Specialties receiving the most frequent referrals were orthopedics (31%), ophthalmology (16%), general surgery (10%), and gynecology (10%). Data from this study suggest that specialty referrals occur infrequently in the Student Health Service. It would appear that this low referral rate, along with a relatively small student population, would not justify provision of in-house specialty consultation in the Student Health Service.

“The Prognosis of Inflammatory Bowel Disease,” DAVID J. SALES AND JOSEPH B. KIRSNER. The complications of ulcerative colitis generally develop during the first two years of disease. The mortality is higher than expected and the highest likelihood of colectomy also occurs early in the disease. Mortality in Crohn's disease is greater than expected, especially in males. For both conditions, the overall mortality has decreased steadily, and currently is less than 5%. Ulcerative colitis is curable with proctocolectomy and lieostomy. In Crohn's disease, intestinal resection and reanastomosis is followed by recurrence in the majority of patients. The recurrence rate after proctocolectomy and lieostomy for Crohn's disease of the colon also is considerable, ranging from 20% to 35%. In ulcerative colitis, the more colon involved, the more frequent and more serious are the complications. In Crohn's disease, the anatomic pattern of disease tends to predict the type and extent of complications. Both ulcerative colitis and Crohn's disease appear to follow a more severe course in children and adolescents with “inflammatory bowel disease.” Patients with either ulcerative colitis or Crohn's disease are at increased risk for the later development of cancer. In ulcerative colitis, the excess risk is limited to colorectal cancer. Patients with Crohn's disease have increased cancer rates for both the small and large bowel. Finally, most patients with these diseases are able to maintain normal occupations and enjoy reasonably stable social and economic situations. The successful adaptation of patients with inflammatory bowel disease is influenced by a hopeful, optimistic personality and by an encouraging, supportive physician.