How to write effective referral letters

Referral letters are the key mode of communication between GPs and hospital specialists for routine and acute management of conditions. While verbal communication skills are strongly emphasized in undergraduate training, written communication is relatively neglected. Medical students and postgraduate doctors are rarely formally taught to write referral letters; it is a skill learnt on the job through opportunistic and informal tuition and by reading referral letters written by others. Consequently, the style, content and quality of referral letters differ greatly among doctors. This article discusses professional expectations, outlines components of effective referral writing and provides a referral letter template

Caenorhabditis elegans Inositol 5-Phosphatase Homolog Negatively Regulates Inositol 1,4,5-Triphosphate Signaling in Ovulation

Ovulation in Caenorhabditis elegans requires inositol 1,4,5-triphosphate (IP(3)) signaling activated by the epidermal growth factor (EGF)-receptor homolog LET-23. We generated a deletion mutant of a type I 5-phosphatase, ipp-5, and found a novel ovulation phenotype whereby the spermatheca hyperextends to engulf two oocytes per ovulation cycle. The temporal and spatial expression of IPP-5 is consistent with its proposed inhibition of IP(3) signaling in the adult spermatheca. ipp-5 acts downstream of let-23, and interacts with let-23–mediated IP(3) signaling pathway genes. We infer that IPP-5 negatively regulates IP(3) signaling to ensure proper spermathecal contraction

No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study

The objective of this prospective randomised study was to analyse the effect of the forearm support band and of strengthening exercises for the treatment of tennis elbow. Twenty-nine patients with 30 tennis elbows were randomised into 3 groups of treatment: (I) forearm support band, (II) strengthening exercises and (III) both methods. The patients had a standardised examination at their first visit, and then after 6 weeks, 3 months and 1 year. At the latest follow-up, there was a significant improvement of the symptoms compared to before treatment (p<0.0001), considering all patients independently of the methods of treatment. However, no differences in the scores were found between the 3 groups of treatment (p=0.27), indicating that no beneficial influence was found either for the strengthening exercises or for the forearm support band. Improvement seems to occur with time, independent of the method of treatment used

The Three Basic Types of Residuals for a Linear Model

We consider residuals for the linear model with a general covariance structure. In contrast to the situation where observations are independent there are several alternative definitions. We draw attention to three quite distinct types of residuals: the marginal residuals, the model-specified residuals and the full-conditional residuals. We adopt a very broad perspective including linear mixed models, time series and smoothers as well as models for spatial and multivariate data. We concentrate on defining these different residual types and discussing their interrelationships. The full-conditional residuals are seen to play several important roles. Copyright 2007 The Authors. Journal compilation (c) 2007.