title: Assessment of the effects of intensive training of community based staff in the screening of children for disorders of growth and puberty.
abstract: BACKGROUND
  The effects of an intensive training programme involving screening of children for disorders of growth and puberty for community based nursing and medical staff employed by Cardiff Community Healthcare NHS Trust were audited to assess the impact of this training on referrals to the local hospital based growth clinic.
  
  
  METHODS
  Referrals from community based staff to the growth clinic of patients living in the geographical area in which staff underwent training were compared with those from general practitioners in the 18 months prior to and following the training programme. Hospital notes were available for 209 of 254 (82.2%) patients identified. We excluded 112 referrals as they did not have a problem relating to growth or puberty or were inter-hospital referrals. Hence 97 referrals were included in the final audit.
  
  
  RESULTS
  Forty referrals occurred prior to compared with 57 following the training programme. The number of referrals from community based staff increased threefold during the six months immediately following the training programme but then returned to the previous level. There were no differences in age or height standard deviation scores at referral between groups at any time. The proportion of children referred from the community with significant abnormalities of growth or puberty (for example, hypothyroidism or precocious puberty) increased from two of 15 referrals to six of 30 referrals following the training programme.
  
  
  CONCLUSIONS
  Intensive training in screening for disorders of growth and puberty can increase the number of referrals of children with significant pathology but at the cost of increased total number of referrals. The increase in referrals is not sustained with time, suggesting continued training is necessary.
authors.affiliation: Department of Child Health, University Hospital of Wales, Heath Park, Cardiff CF4 4XW, UK. Cowan_FJ@hotmail.com
authors.forename: F J
authors.initials: FJ
authors.lastname: Cowan
authors.forename: J W
authors.initials: JW
authors.lastname: Gregory
mesh_terms: D000293:Adolescent; D001827:Body Height; D001835:Body Weight; D002648:Child; D003153:Community Health Services; D003154:Community Medicine / Q000193:education*; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D006058:Gonadal Disorders / Q000175:diagnosis*; D006130:Growth Disorders / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening; D009726:Nurses; D011627:Puberty; D011629:Puberty, Precocious / Q000175:diagnosis; D014852:Wales