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Figueroa-Parra G, Castañeda-Martinez MM, Herrera-Sandate P, Castañeda-Martinez DD, Esquivel-Valerio JA, Vega-Morales D. Clinical features of patients with hands arthralgia referred from primary care physicians to rheumatologists: A cohort study. Reumatol Clin (Engl Ed) 2024; 20:67-72. [PMID: 38395497 DOI: 10.1016/j.reumae.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/28/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE Early referral of patients with suspicious of rheumatoid arthritis (RA) has an impact on prognosis. Our study aimed to evaluate the clinical characteristics of patients with hands arthralgia who were referred from primary care physicians (PCP) to the rheumatologist. METHODS A descriptive, observational, prospective cohort study was performed. We included patients who visited a PCP for the first time for hands arthralgia. Demographics and the European Alliance of Associations for Rheumatology criteria for arthralgia suspicious for progression to RA plus seven complementary questions, the time to referral, the pressure needed to provoke pain with an automatic squeeze test machine in the metacarpophalangeal joints of both hands, and the diagnoses established at the last review of medical charts from patients on follow-up were documented. The primary outcome was the referral to a rheumatologist. RESULTS A total of 109 patients were included. The mean age was 49.9 years, 81.6% were women. 30.3% were referred to the rheumatologist. The time to referral was a median of 38 days. The main clinical characteristics associated with referral to the rheumatologist were the "most severe symptoms are present after midnight" (OR=6.29) and the "difficulty with making a fist" (OR=3.67). An isolated "positive squeeze test of metacarpophalangeal joints" was not associated with a referral to the rheumatologist. CONCLUSIONS Among patients with hands arthralgia who attended PCP, those with most severe symptoms after midnight and difficulty making a fist were more likely to be referred to the rheumatology clinic. Isolated positive squeeze tests are not a parameter for referral, it should only be performed if arthralgia is clinically suspected.
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Affiliation(s)
- Gabriel Figueroa-Parra
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Pablo Herrera-Sandate
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Vega-Morales
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico.
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Nielsen AW, Hemmig AK, de Thurah A, Schmidt WA, Sattui SE, Mackie SL, Brouwer E, Dejaco C, Keller KK, Mukhtyar CB. Early referral of patients with suspected polymyalgia rheumatica - A systematic review. Semin Arthritis Rheum 2023; 63:152260. [PMID: 37639896 DOI: 10.1016/j.semarthrit.2023.152260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Prompt diagnosis and treatment of polymyalgia rheumatica (PMR) is crucial to prevent long-term complications and improve patient outcomes. However, there is currently no standardized approach to referral of suspected PMR patients to rheumatologists, leading to inconsistent management practices. The objective of this systematic review was to clarify the existing evidence regarding the following aspects of early management strategies in patients with suspected PMR: diagnostic strategies, GCA screening, glucocorticoid initiation prior to referral, value of shared care and value of fast track clinic. METHODS Two authors performed a systematic literature search, data extraction and risk of bias assessment independently. The literature search was conducted in Embase, MEDLINE (PubMed) and Cochrane. Studies were included if they contained cohorts of suspected PMR patients and evaluated the efficacy of different diagnostic strategies for PMR, screening for giant cell arteritis (GCA), starting glucocorticoids before referral to secondary care, shared care, or fast-track clinics. RESULTS From 2,437 records excluding duplicates, 14 studies met the inclusion criteria. Among these, 10 studies investigated the diagnostic accuracy of various diagnostic strategies with the majority evaluating different clinical approaches, but none of them showed consistently high performance. However, 4 studies on shared care and fast-track clinics showed promising results, including reduced hospitalization rates, lower starting doses of glucocorticoids, and faster PMR diagnosis. CONCLUSION This review emphasizes the sparse evidence of early management and referral strategies for patients with suspected PMR. Additionally, screening and diagnostic strategies for differentiating PMR from other diseases, including concurrent GCA, require clarification. Fast-track clinics may have potential to aid patients with PMR in the future, but studies will be needed to determine the appropriate pre-referral work-up.
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Affiliation(s)
- A W Nielsen
- Department of Rheumatology, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - A K Hemmig
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - A de Thurah
- Department of Rheumatology, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - W A Schmidt
- Medical Centre for Rheumatology, Klinik für Innere Medizin, Rheumatologie und Klinische Immunologie Berlin-Buch, Immanuel Krankenhaus, Berlin, Germany
| | - S E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA (S.E.S.)
| | - S L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria; Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - K K Keller
- Department of Rheumatology, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C B Mukhtyar
- Vasculitis service, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
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Barnett R, Gaffney K, Sengupta R. Diagnostic delay in axial spondylarthritis: A lost battle? Best Pract Res Clin Rheumatol 2023; 37:101870. [PMID: 37658016 DOI: 10.1016/j.berh.2023.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
Diagnostic delay in axial spondylarthritis (axSpA) remains an unacceptable worldwide problem; with evidence suggesting significant detrimental impact both clinically on the individual, and economically on society. There is therefore, a need for global action across various healthcare professions that come into contact with patients living, and suffering, with undiagnosed axSpA. Recent estimates of the median diagnostic delay suggest that globally, individuals with axSpA wait between 2 and 6 years for a diagnosis - revealing a clear benchmark for improvement. This timespan presents a window of opportunity for earlier diagnosis and intervention, which will likely improve patient outcomes. This review describes the current diagnostic delay as estimated across countries and over time, before presenting evidence from published strategies that may be implemented to improve this delay across primary and secondary care, including for specialties treating extra-musculoskeletal manifestations of axSpA (ophthalmology, gastroenterology, dermatology). Ongoing campaigns tackling delayed diagnosis in axSpA are also highlighted.
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Affiliation(s)
- Rosemarie Barnett
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK; Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk & Norwich, University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - Raj Sengupta
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
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Bart NK, Lakdawala N. Don't Miss the Boat! Determining Optimal Time of Referral for Cardiac Transplantation. Heart Lung Circ 2022; 31:1561-1562. [PMID: 36549839 DOI: 10.1016/j.hlc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nicole K Bart
- Heart Failure and Transplant Program, St Vincent's Hospital, Sydney, NSW, Australia; School of Medicine University of Notre Dame, Sydney, NSW, Australia; School of Medicine, University of New South Wales, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia.
| | - Neal Lakdawala
- Brigham and Women's Hospital, Boston, MA, USA; Boston VA Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Reddy SM, Shaik N, Pudi S, Yennavaram VK, Kotha A, Avidapu R. Assessing the Pediatricians' Role in Improving Young Children's Oral Health in Telangana State: A Cross-sectional Study. Int J Clin Pediatr Dent 2022; 15:591-595. [PMID: 36865720 PMCID: PMC9973115 DOI: 10.5005/jp-journals-10005-2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Primary precautionary approaches for oral health is an essential tool concerning public health, as dental caries is one of the eminently prevailing chronic diseases among children across the globe. As pediatricians and pediatric healthcare professionals are more likely to encounter children when compared to general dentists, it is crucial for them to be acquainted with possible risk factors and diseases occurring in early childhood. Therefore, it is highly advocated to take necessary steps at an initial stage to help promote pragmatic results during childhood and succeeding adulthood phases. Objectives The pediatrician's attitude toward dental health and his dental screening, counseling, and referral practices. Material and methods This was a cross-sectional study in the Hyderabad district, following area sampling on a sample of 200 child healthcare professionals, as calculated based on a pilot study. A definitive and validated questionnaire was used for the collection of data, and pediatric health professionals were approached in their workplaces. Results About 44.5% of pediatricians usually check teeth during routine tongue and throat examinations. Around 59.5% of them suspect cavities when the child looks undernourished. A total of >80% of them voted that oral health cannot be neglected, as it is an integral part of a child's general health and dental screening, and referral at regular intervals of time is their responsibility. Only 8.5% advised fluoridated toothpaste, whereas only 62.5% counseled parents on the dental ill effects of nighttime bottle-feeding and digit sucking. Conclusion Although all the pediatricians had appropriate attitudes toward oral health, they were not put into action by many. Dental public health significance Pediatricians play a vital role as potential partners in the oral health promotion of children and their families. A pediatric primary care provider's regular screening, counseling, and referral would help his/her patients in getting the right treatment done at the right time. How to cite this article Reddy SM, Shaik N, Pudi S, et al. Assessing the Pediatricians' Role in Improving Young Children's Oral Health in Telangana State: A Cross-sectional Study. Int J Clin Pediatr Dent 2022;15(5):591-595.
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Affiliation(s)
- Sushma Mudhi Reddy
- Department of Public Health Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Naseemoon Shaik
- Department of Pedodontics & Preventive Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Sriharsha Pudi
- Department of Prosthodontics Crown and Bridge, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Vijay Kumar Yennavaram
- Department of Public Health Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Arpitha Kotha
- Department of Public Health Dentistry, MNR Dental College & Hospital, Sangareddy, Telangana, India
| | - Rajashekhar Avidapu
- Department of Public Health Dentistry, MNR Dental College and Hospital, Hyderabad, Telangana, India
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Sala A, Lorusso R, Alfieri O. Isolated tricuspid valve surgery: beyond the idea of a high-mortality surgery. Eur J Cardiothorac Surg 2022; 62:6542522. [PMID: 35244688 DOI: 10.1093/ejcts/ezac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alessandra Sala
- Vita-Salute San Raffaele University, Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Ottavio Alfieri
- Vita-Salute San Raffaele University, Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Milan, Italy
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Meloni M, Lazaro-Martínez JL, Ahluwalia R, Bouillet B, Izzo V, Di Venanzio M, Iacopi E, Manu C, Garcia-Klepzig JL, Sánchez-Ríos JP, Lüedemann C, De Buruaga VRS, Vouillarmet J, Guillaumat J, Aleandri AR, Giurato L, Edmonds M, Piaggesi A, Van Acker K, Uccioli L. Effectiveness of fast-track pathway for diabetic foot ulcerations. Acta Diabetol 2021; 58:1351-1358. [PMID: 33942178 PMCID: PMC8413149 DOI: 10.1007/s00592-021-01721-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 01/22/2023]
Abstract
AIM To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | | | - Raju Ahluwalia
- Department of Trauma and Ortophaedic Department, King ́s College Hospital, London, UK
| | | | - Valentina Izzo
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Elisabetta Iacopi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | - Chris Manu
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | | | | | | | | | | | | | | | - Laura Giurato
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Micheal Edmonds
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | - Alberto Piaggesi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | | | - Luigi Uccioli
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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8
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Satija A, Lorenz K, DeNatale M, Mickelsen J, Deo SS, Bhatnagar S. Early Referral to Palliative Care for Advanced Oral Cancer Patients: A Quality Improvement Initiative in Oncology Center at All India Institute of Medical Sciences. Indian J Palliat Care 2021; 27:230-234. [PMID: 34511789 PMCID: PMC8428875 DOI: 10.25259/ijpc_367_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/20/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: Oral cancers have high epidemiologic burden in India, and most oral cancer patients at the All India Institute of Medical Sciences present in advanced stages. Their symptomatic needs are often not adequately addressed and the referrals to palliative medicine clinic are for severe pain or terminal stages. Using quality improvement methods, we aimed to provide early referral to palliative care for advanced oral cancer patients. Materials and Methods: Duration (number of days) between registration at the head-and-neck cancer clinic and referral to palliative medicine clinic at baseline and postinterventions. Interventions: Understanding current perceptions of oncologists for referral to palliative medicine clinic, educating them through departmental meetings, fostering clinician and patient-family awareness through pamphlets, defining process and screening guidelines for referral, including symptom burden charts in head-and-neck cancer clinic notes, soliciting regular feedback from oncologists at review meetings. Results: The number of days for the referral to the palliative medicine clinic decreased from an average of 48 days to 13 days in 6 months. Conclusion: A multicomponent intervention included oncologists and patients and families, education, workflow modification, standardized assessment, documentation, and clinician feedback, and succeeded in improving the timeliness of palliative care referrals of advanced oral cancer patients.
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Affiliation(s)
- Aanchal Satija
- Departments of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Karl Lorenz
- VA Palo Alto Healthcare System, Palo Alto, California, USA.,Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | - Sv Suryanarayana Deo
- Surgical Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Departments of Onco-Anaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
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Boltezar L, Novakovic BJ, Moltara ME. Trends in specialized palliative care referrals at an oncology center from 2007 to 2019. BMC Palliat Care 2021; 20:135. [PMID: 34479512 PMCID: PMC8418009 DOI: 10.1186/s12904-021-00828-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early referral to palliative care, at least 3 months before death, should be a standard of care in oncological practice. Real life data in this setting are invaluable since they provide a picture of everyday practice and serve as the basis for future improvements. METHODS We conducted a retrospective cohort assessment of all patients referred to our specialized palliative care (SPC) services at the Institute of Oncology, Ljubljana, Slovenia. Our analysis includes patient referrals between 2007 and 2019. RESULTS During the above-specified time period of 13 years, 3234 patients were referred for SPC services at our institution. The median age at SPC referral was 67 years. The majority of patients (63%) were assessed only once, while 31% of patients were seen on more than one occasion. Median time from SPC referral to death was 25 days for the whole group. 1693 patients (52.7%) were referred to SPC in the last 30 days before death, 785 (25.8%) patients between 31 and 90 days and 652 (21.4%) patients more than 3 months before death. Neither age nor sex correlated with the duration of referral time. However, there was a strong correlation between the year of referral to palliative care and the duration of palliative care service (ρ = 0.19, p < 0.001). The median referral to death interval for lymphoma patients and breast cancer patients were 15 and 18 days, respectively, and the median referral to death interval for colorectal cancer and lung tumor patients were 34 and 26 days before death, respectively. CONCLUSION Throughout the existence of our SPC services we have observed a positive trend in the number of referrals, a lengthening of time between referral and death, as well as an increase in the proportion of patients with an early referral to SPC (more than 3 months before death). Neither age nor sex correlated with the length of referral time.
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Affiliation(s)
- Lucka Boltezar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
| | - Barbara Jezersek Novakovic
- Department of Medical Oncology, Institute of Oncology Ljubljana, Zaloska cesta 2, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia
| | - Maja Ebert Moltara
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, Ljubljana, Slovenia. .,Acute Palliative Care Department, Institute of Oncology Ljubljana, Zaloska cesta 2, Ljubljana, Slovenia.
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Contreras-Yáñez I, Guaracha-Basáñez G, Díaz-Borjón E, Iglesias M, Pascual-Ramos V. Early referral and control of disease's flares prevent Orthopedic and Hand Surgery Indication (OHSI) in a dynamic cohort of Hispanic early rheumatoid arthritis patients. BMC Musculoskelet Disord 2018; 19:378. [PMID: 30340571 PMCID: PMC6195740 DOI: 10.1186/s12891-018-2299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/05/2018] [Indexed: 11/29/2022] Open
Abstract
Background Reconstructive joint surgery is an indicator of poor prognosis in rheumatoid arthritis (RA). Objectives of this study were to describe the incidence rate of orthopedic and hand surgery indication (OHSI) in an ongoing cohort of Hispanic early RA patients treated according to a T2T strategy and to investigate predictors. Methods Through February 2018, the cohort comprised 185 patients recruited from 2004 onwards, with variable follow-up, and rheumatic assessments at fixed intervals that included prospective determination of OHSI. Charts were reviewed by a single data abstractor. OHSI incidence rate was calculated. A case-control study nested within a cohort investigated the predictors; cases (OHSI patients) were paired with controls (1:4) according to age, sex and autoantibodies. A logistic regression model included baseline and cumulative (up to OHSI or equivalent) variables related to disease activity, treatment and to persistence with therapy. The IRB approved the study. Results Patients from the cohort were predominantly middle-aged (mean ± SD age: 38.5 ± 12.9 years) females (87.6%) with 5.4 ± 2.6 months of disease duration. The cohort contributed to 1538 patient-years of follow-up. Twelve patients received incidental OHSI at a follow-up of 85 ± 44.5 months. The OHSI incident global rate was 8/1000 patient-years. Longer symptom duration at cohort referral (OR: 1.313, 95%CI: 1.02–1.68, p = 0.032) and a higher number of flares/patient (OR: 1.608, 95%CI: 1.05–1.61, p = 0.015) predicted OHSI. OHSI patients had more severe flares than their counterparts, and the opposite figure was true for mild flares. Conclusion Early referral for appropriate management and flare control may prevent OHSI in Hispanic recent-onset RA patients.
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Affiliation(s)
- Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Belisario Domínguez, 14500, Ciudad de México, CP, Mexico
| | - G Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Belisario Domínguez, 14500, Ciudad de México, CP, Mexico
| | - E Díaz-Borjón
- Department of Surgery, Orthopedic Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Iglesias
- Department of Surgery, Plastic Surgery Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - V Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Belisario Domínguez, 14500, Ciudad de México, CP, Mexico.
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11
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De Wilde M, Speeckaert M, Van Biesen W. Can increased vigilance for chronic kidney disease in hospitalised patients decrease late referral and improve dialysis-free survival? BMC Nephrol 2018; 19:74. [PMID: 29606094 PMCID: PMC5880091 DOI: 10.1186/s12882-018-0869-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 03/12/2018] [Indexed: 11/26/2022] Open
Abstract
Background Insufficient vigilance for renal insufficiency is associated with late referral, increased morbidity and mortality. The present study examines whether increased vigilance for chronic kidney disease (CKD) leads to quicker referral to and better follow-up by a nephrologist, and whether it is associated with an improved outcome. Methods Patients with an eGFR < 45 ml/min/1.73 m2 during hospitalisation at the Ghent University Hospital were enrolled during a period of 100 days. The patients were interviewed about their awareness of CKD. Both the patients and their general practitioner were subsequently informed about CKD. The primary endpoint was the number of patients referred for nephrological follow-up within three months. The secondary endpoint was need for dialysis and mortality from any cause one year after inclusion. Results Of the 72 included patients, 54 had proven CKD, with eGFR consistently < 45 ml/min/1.73 m2 during at least three months before inclusion. Merely 65% was aware of having CKD and only 41% was in regular nephrological follow-up. After intervention, the percentage of patients with CKD in follow-up increased from 41% to 71% (p = 0.002). The proportion reaching the secondary endpoint was significant lower in the patients who were referred quickly than in those who were not (p = 0.015). Similarly, the proportion was significant lower in the patients who received nephrological follow-up than in those who did not (p = 0.006). Conclusion Vigilance for CKD is poor. Simple interventions to augment the vigilance for CKD, as presented in this study, lead to a quicker referral to and follow-up by a nephrologist, which may result in better outcome.
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Affiliation(s)
- M De Wilde
- Department of Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - M Speeckaert
- Department of Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - W Van Biesen
- Department of Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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Mohammad N, Shaikh S, Memon S, Das H. Spectrum of heart disease in children under 5 years of age at Liaquat University Hospital, Hyderabad, Pakistan. Indian Heart J 2014; 66:145-9. [PMID: 24581115 PMCID: PMC3946440 DOI: 10.1016/j.ihj.2013.12.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 12/24/2022] Open
Abstract
Objective & methodology This was a descriptive cross sectional study of one year duration conducted in Pediatric department of Liaquat University Hospital, Hyderabad. The objective was to assess the clinical pattern, age distribution and type of heart diseases in children under 5 years of age. In this study 150 children with suspicion of cardiac problem were enrolled. Result Among 150 cardiac patients 55.3% were male and 44.7% were female. Congenital heart diseases (CHD) seen in 89.3% and 10.7% had acquired heart disease. Among CHD 74.6% were Acyanotic lesions while cyanotic lesions were seen in 23.9% and 1.5% were cases of dextrocardia. Ventricular septal defect was the commonest Acyanotic lesion (29.9%) followed by atrial septal defect (25.4%). Among cyanotic heart diseases tetralogy of Fallot was the commonest lesion seen in 11.2% followed by transposition of great arteries and complex heart defect 5.2% and 3% respectively. Among acquired heart disease myocarditis was the commonest disease accounts 94% and pericardial effusion was seen in 6%. Conclusion Regarding the type of congenital heart defect acyanotic defect was more common than cyanotic with ventricular septal defect commonest lesion. Tetralogy of Fallot's was commonest in cyanotic group. Availability of expertise locally will lead to more patients getting surgical treatment at an earlier age thereby reducing morbidity and mortality and improving quality of life for these children.
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Affiliation(s)
- Nadia Mohammad
- Senior Registrar Pediatric Department, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Salma Shaikh
- Professor of Pediatrics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Shazia Memon
- Assistant Professor of Pediatrics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.
| | - Heman Das
- FCPS Resident of Pediatrics, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
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Abstract
In the trajectory of disease progress and treatment plan, patients and the family members are confronted with challenging situations like unsurmountable physical distress, inadequate coping patterns, unanswered spiritual issues in the background of serious threat to very existence of life leads to a debilitating Quality of life.The Palliative Care team approach addresses all the issues and also sees the patient to go through the protocols of Palliative care management as well as Oncological treatment plan. Further, this fecilitates a smooth transition from the hospital to home and hospice care. Various studies conducted globally revealed that patients received palliative care intervention along with oncological treatments had higher scores of Quality of life compared to patients received onlyoncology care alone.This article discusses the various factors contributing to late referrals to palliative care team and also care giver’s views pertaining to need for early referral. Timely referral to palliative care minimises the patient’s and care giver’s distress, ensures modest Quality of life and appropriate measures at the end of life care.
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Affiliation(s)
- P Saraswathi Devi
- Department of Anaesthesiology and Pain Relief, Kidwai Memorial Institute of Oncology, Bangalore, India
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