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Martín-Enguix D, Pérez-Fernández N, Gomez-Gabaldón N, Medina-Gámez JA, Morales-Escobar FJ. [Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document]. Semergen 2024; 50:102114. [PMID: 37832471 DOI: 10.1016/j.semerg.2023.102114] [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: 07/31/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.
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Affiliation(s)
- D Martín-Enguix
- Medicina Familiar y Comunitaria, Centro de Salud Albuñol, Distrito Sanitario Granada Sur, Albuñol, Granada, España.
| | - N Pérez-Fernández
- Otorrinolaringología, Clínica Universidad de Navarra, Madrid, España
| | - N Gomez-Gabaldón
- Medicina Familiar y Comunitaria, Otorrinolaringología, Hospital de Hellín, Hellín, Albacete, España
| | - J A Medina-Gámez
- Neurología, Medicina Familiar y Comunitaria, Centro de Salud de Armilla, Distrito Sanitario Granada Metropolitano, Armilla, Granada, España
| | - F J Morales-Escobar
- Medicina Familiar y Comunitaria, Centro de Salud Arucas, Arucas, Las Palmas, España
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Khayyat SM. Consensus methodology to investigate the crucial referral criteria to pharmacist-led counseling clinics in Makkah City. Saudi Pharm J 2024; 32:101981. [PMID: 38370133 PMCID: PMC10869262 DOI: 10.1016/j.jsps.2024.101981] [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] [Received: 10/08/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Aim Identifying and prioritizing criteria for referring patients to a counseling clinic managed by hospital pharmacists in the tertiary care setting in Saudi Arabia (SA). Method A two-phase consensus Delphi methodological approach was adopted in this study. Data was collected from physicians and pharmacists from different specialties working in different hospitals in Makkah City. In Phase 1, semi-structured interviews were conducted with physicians and pharmacists to discuss and develop the initial list of potential referral criteria for post-discharge counseling. Phase 2 consisted of two rounds of online surveys where participants were asked to independently rank the referral criteria using a 5-point Likert Scale. Results In Phase 1, four participants undertook the interviews (two physicians and two pharmacists). Overall, no major comments were given on the suggested criteria. In Phase 2, most suggested referral criteria to the counseling clinic reached participants' consensus agreement of >70 % in both rounds for all three domains. Among all criteria that achieved consensus agreement, two demographic criteria were top-ranked by the participants; the elderly patients (100 %) and those who needed help with their devices (96 %). These were followed by five medication-related criteria, which are medication-related problems, polypharmacy, medication that needs monitoring, high-risk medication, and medication with special formulations. All had a consensus agreement of 96 %. Conclusion This study suggests that a counseling clinic led by pharmacists is particularly advisable for the elderly, individuals requiring assistance with their devices, and those encountering medication issues. It is essential to prioritize specific patient demographics when contemplating the extensive establishment and integration of such clinics across various hospitals in SA.
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Affiliation(s)
- Sarah M. Khayyat
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Ferri-Rufete D, López-González A, Casas-Alba D, Cuadras D, Palau F, Martínez-Monseny A. Clinical Genetics Assessment Triangle (CGAT): A simple tool to identify patients with genetic conditions. Eur J Med Genet 2023; 66:104858. [PMID: 37758166 DOI: 10.1016/j.ejmg.2023.104858] [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: 07/03/2023] [Revised: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The objective of this study was to develop a simple tool for general physicians to promptly identify and refer pediatric patients with a higher probability of having a genetic condition. STUDY DESIGN This retrospective, descriptive study was conducted at a tertiary pediatric hospital's Clinical Genetics Unit from June 2019 to January 2020. We included patients under 18 years of age who visited the unit, excluding those without genetic testing. Epidemiological, clinical, and genetic variables were collected from electronic medical records. The primary outcome was the diagnosis of a genetic condition based on genetic testing. RESULTS Among 445 patients, 304 were included; 163 (53.6%) were male, and mean age was 7.4 years (SD 5.1 years). A genetic condition was diagnosed in 139 patients (45.7%). Using a multiple logistic regression model, five variables significantly contributed to reaching a diagnosis: suspected diagnosis at referral (OR 3.45, P < 0.001), short stature (OR 3.11, P < 0.001), global developmental delay/intellectual disability (OR 2.65, P < 0.001), dysmorphic craniofacial features (OR 1.99, P = 0.035), and multiple congenital anomalies (OR 2.54, P = 0.033). The association strength (OR) increased when these variables were paired with each other. The study's findings are presented in the form of a triangle, known as the Clinical Genetics Assessment Triangle (CGAT), which summarizes the results. A decision tree model is applied to guide clinical department referrals based on the affected sides of the triangle. CONCLUSIONS The CGAT has the potential to enable general physicians to promptly identify pediatric patients with an increased probability of having a genetic condition.
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Affiliation(s)
- David Ferri-Rufete
- Pediatrics Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950, Spain.
| | - Aitor López-González
- Pediatrics Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950, Spain.
| | - Dídac Casas-Alba
- Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950, Spain.
| | - Daniel Cuadras
- Statistics Department, Fundació Sant Joan de Déu, Esplugues de Llobregat, 08950, Spain.
| | - Francesc Palau
- Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| | - Antonio Martínez-Monseny
- Department of Genetic Medicine, Pediatric Institute of Rare Diseases (IPER), Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950, Spain.
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Hedegaard BS, Bork CS, Kanstrup HL, Thomsen KK, Heitmann M, Bang LE, Henriksen FL, Andersen LJ, Gohr T, Mouridsen MR, Soja AMB, Elpert FP, Jakobsen TJ, Sjøl A, Joensen AM, Nordestgaard BG, Klausen IC, Schmidt EB. Genetic testing increases the likelihood of a diagnosis of familial hypercholesterolaemia among people referred to lipid clinics: Danish national study. Atherosclerosis 2023; 373:10-16. [PMID: 37080006 DOI: 10.1016/j.atherosclerosis.2023.04.003] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND AIMS It is unclear to what extent genetic testing improves the ability to diagnose familial hypercholesterolaemia (FH). We investigated the percentage with FH among individuals referred to Danish lipid clinics, and evaluated the impact of genetic testing for a diagnosis of FH. METHODS From September 2020 through November 2021, all patients referred for possible FH to one of the 15 Danish lipid clinics were invited for study participation and >97% (n = 1488) accepted. The Dutch Lipid Clinical Network criteria were used to diagnose clinical FH. The decision of genetic testing for FH was based on local practice. RESULTS A total of 1243 individuals were referred, of whom 25.9% were diagnosed with genetic and/or clinical FH. In individuals genetically tested (n = 705), 21.7% had probable or definite clinical FH before testing, a percentage that increased to 36.9% after genetic testing. In individuals with unlikely and possible FH before genetic testing, 24.4% and 19.0%, respectively, had a causative pathogenic variant. CONCLUSIONS In a Danish nationwide study, genetic testing increased a diagnosis of FH from 22% to 37% in patients referred with hypercholesterolaemia suspected of having FH. Importantly, approximately 20% with unlikely or possible FH, who without genetic testing would not have been considered having FH (and family screening would not have been undertaken), had a pathogenic FH variant. We therefore recommend a more widespread use of genetic testing for evaluation of a possible FH diagnosis and potential cascade screening.
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Affiliation(s)
- Berit Storgaard Hedegaard
- The Danish FH Study Group, Denmark; Department of Cardiology, Regional Hospital Central Jutland, Viborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev Gentofte, Herlev, Denmark.
| | - Christian Sørensen Bork
- The Danish FH Study Group, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Lynge Kanstrup
- The Danish FH Study Group, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kristian Korsgaard Thomsen
- The Danish FH Study Group, Denmark; Department of Cardiology, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Merete Heitmann
- The Danish FH Study Group, Denmark; Department of Cardiology, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - Lia Evi Bang
- The Danish FH Study Group, Denmark; The Heart Center, Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Finn Lund Henriksen
- The Danish FH Study Group, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars Juel Andersen
- The Danish FH Study Group, Denmark; Department of Cardiology Zealand University Hospital, Roskilde, Denmark
| | - Thomas Gohr
- The Danish FH Study Group, Denmark; Department of Cardiology, Lillebælt Hospital, Kolding, Denmark
| | - Mette Rauhe Mouridsen
- The Danish FH Study Group, Denmark; Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Anne Merete Boas Soja
- The Danish FH Study Group, Denmark; Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | - Frank-Peter Elpert
- The Danish FH Study Group, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Tomas Joen Jakobsen
- The Danish FH Study Group, Denmark; Department of Cardiology, North Zealand Hospital, Frederikssund, Denmark
| | - Anette Sjøl
- The Danish FH Study Group, Denmark; Department of Cardiology, Amager-Hvidovre Hospital, Denmark
| | - Albert Marni Joensen
- The Danish FH Study Group, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Børge Grønne Nordestgaard
- The Danish FH Study Group, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev Gentofte, Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital, Herlev Gentofte, Herlev, Denmark
| | - Ib Christian Klausen
- The Danish FH Study Group, Denmark; Department of Cardiology, Regional Hospital Central Jutland, Viborg, Denmark
| | - Erik Berg Schmidt
- The Danish FH Study Group, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Young C, Reid B. Referral criteria: perceptions and experiences of district nursing students in Northern Ireland. Br J Community Nurs 2021; 26:532-538. [PMID: 34731033 DOI: 10.12968/bjcn.2021.26.11.532] [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] [Indexed: 06/13/2023]
Abstract
An ever-ageing population and widening health inequalities intensify the complexity of care that is now delivered within community settings by district nurses. Appropriate referral criteria are required to facilitate the enhancement of efficient and equitable district nursing service provision. This study aimed to explore district nursing students' perceptions and experiences of district nursing referral criteria in Northern Ireland. A qualitative phenomenological approach was adopted using a purposive convenience sample of 10 district nursing students. Data were collected during online focus group interviews and analysed using a thematic framework. Four themes emerged: referral criteria; insight and inconsistency; task versus patient-centred care; and misunderstanding the service and referral quality. The themes reflect a lack of consensus with respect to referral criteria, contributing to inappropriate and poor-quality referrals. Appropriate and quality referrals to district nursing services are key to assuring sustainable service provision. Suitable access to district nursing services may be enhanced by developing consensus referral criteria.
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Affiliation(s)
- Charlene Young
- District Nursing Team Leader, Northern Health and Social Care Trust, Northern Ireland
| | - Bernie Reid
- Lecturer in Nursing, School of Nursing, Ulster University, Magee Campus, Derry/Londonderry, Northern Ireland
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Nadkarni Y, Kukec I, Gruber P, Jhanji S, Droney J. Integrated palliative care: triggers for referral to palliative care in ICU patients. Support Care Cancer 2021; 30:2173-2181. [PMID: 34704155 DOI: 10.1007/s00520-021-06542-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Palliative care within intensive care units (ICU) benefits decision-making, symptom control, and end-of-life care. It has been shown to reduce the length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence to support screening ICU patients using palliative care referral criteria or "triggers". The aim of the project was to assess the need for palliative care referral during ICU admission using "trigger" tools. METHODS Electronic record review of cancer patients who died in or within 30 days of discharge from oncology ICU, between 2016 and 2018. Patients referred to palliative care before or during ICU admission were identified. Three sets of palliative care referral "triggers" were applied: one that is being tested locally and two internationally derived tools. The proportion of patients who met any of these triggers during their final ICU admission was calculated. RESULTS Records of 149 patients were reviewed: median age 65 (range 20-83). Most admissions (89%) were unplanned, with the most common diagnoses being haemato-oncology (31%) and gastrointestinal (16%) cancers. Most (73%) were unknown to palliative care pre-ICU admission; 44% were referred between admission and death. The median time from referral to death was 0 day (range 0-19). On ICU admission, 97-99% warranted referral to palliative care using locally and internationally derived triggers. CONCLUSION All "trigger" tools identified a high proportion of patients who may have warranted a palliative care referral either before or during admission to ICU. The routine use of trigger tools could help streamline referral pathways and underpin the development of an effective consultative model of palliative care within the ICU setting to enhance decision-making about appropriate treatment and patient-centred care.
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Affiliation(s)
- Yashna Nadkarni
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK.
| | - Ivana Kukec
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pascale Gruber
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Shaman Jhanji
- Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK
| | - Joanne Droney
- Symptom Control and Palliative Care Team, Royal Marsden NHS Foundation Trust, London, UK
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Fadol AP, Patel A, Shelton V, Krause KJ, Bruera E, Palaskas NL. Palliative care referral criteria and outcomes in cancer and heart failure: a systematic review of literature. Cardiooncology 2021; 7:32. [PMID: 34556191 PMCID: PMC8459494 DOI: 10.1186/s40959-021-00117-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/09/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. AIMS To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. DESIGN Systematic literature review on PC in patients with HF and in patients with cancer. DATA SOURCES Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. RESULTS Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. CONCLUSION The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.
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Affiliation(s)
- Anecita P Fadol
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Ashley Patel
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Valerie Shelton
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate J Krause
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas L Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
Advanced heart failure (HF) is characterized by a progressive worsening of symptoms disabling for daily life, refractory to all therapies, and with high mortality. These patients may be candidates for life-prolonging therapies, such as heart transplantation (HT) or long-term (LT) mechanical circulatory support (MCS) or must just require palliative therapies. The 1-year survival after HT and/or LT-MCS is approaching 80% to 90%, being patient selection and timely referral to advanced HF centers critical for optimal outcomes. There is no single symptom, sign, or test that can identify these patients and different classifications are complementary and helpful for clinical decision-making.
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Delgado Romero J, Núñez Palomo S, Uréndez Ruiz AM, Gómez Ruiz F, Hidalgo Requena A, Álvarez Gutiérrez FJ. Referral criteria for asthma and the pandemic: new challenges, new responses. J Investig Allergol Clin Immunol 2021; 31:530-532. [PMID: 34489222 DOI: 10.18176/jiaci.0747] [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: 11/20/2022] Open
Affiliation(s)
- J Delgado Romero
- UGC Alergología. Hospital Virgen Macarena. Sevilla. Sociedad Española de Alergología e Inmunología Clínica (SEAIC)
| | - S Núñez Palomo
- CS Torrelaguna. Madrid. Sociedad Española de Medicina Familiar y Comunitaria (semFYC)
| | - A M Uréndez Ruiz
- Urgencias de Atención Primaria, SAMU 061 Balears. Grupo de Respiratorio en Atención Primaria (GRAP)
| | - F Gómez Ruiz
- CS Bargas. Toledo. Sociedad Española de Médicos Generales y de Familia (SEMG)
| | - A Hidalgo Requena
- UGC Lucena. Área Sanitaria Sur de Córdoba. Sociedad Española de Médicos de Atención Primaria (SEMERGEN)
| | - F J Álvarez Gutiérrez
- Unidad de Asma. UMQER. Hospital Universitario Virgen del Rocío. Sevilla. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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Kotnik U, Peterlin B, Lovrecic L. Identification of women at risk for hereditary breast and ovarian cancer in a sample of 1000 Slovenian women: a comparison of guidelines. BMC Cancer 2021; 21:665. [PMID: 34082720 DOI: 10.1186/s12885-021-08400-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background An important number of breast and ovarian cancer cases is due to a strong genetic predisposition. The main tool for identifying individuals at risk is recognizing a suggestive family history of cancer. We present a prospective study on applying three selected clinical guidelines to a cohort of 1000 Slovenian women to determine the prevalence of at-risk women according to each of the guidelines and analyze the differences amongst the guidelines. Methods Personal and family history of cancer was collected for 1000 Slovenian women. Guidelines by three organizations: National Comprehensive Cancer Network (NCCN), American College of Medical Genetics in cooperation with National Society of Genetic Counselors (ACMG/NSGC), and Society of Gynecologic Oncology (SGO) were applied to the cohort. The number of women identified, the characteristics of the high-risk population, and the agreement between the guidelines were explored. Results NCCN guidelines identify 13.2% of women, ACMG/NSGC guidelines identify 7.1% of women, and SGO guidelines identify 7.0% of women from the Slovenian population, while 6.2% of women are identified by all three guidelines as having high-risk for hereditary breast and ovarian cancer. Conclusions We identified 13.7% of women from the Slovenian population as being at an increased risk for breast and ovarian cancer based on their personal and family history of cancer using all of the guidelines. There are important differences between the guidelines. NCCN guidelines are the most inclusive, identifying nearly twice the amount of women as high-risk for hereditary breast and ovarian cancer as compared to the AGMG/NSCG and SGO guidelines in the Slovenian population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08400-8.
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Van Yperen DT, Van Lieshout EMM, Nugteren LHT, Plaisier AC, Verhofstad MHJ, Van der Vlies CH; Burns study group. Adherence to the emergency management of severe burns referral criteria in burn patients admitted to a hospital with or without a specialized burn center. Burns 2021:S0305-4179(21)00059-0. [PMID: 33707084 DOI: 10.1016/j.burns.2021.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/31/2021] [Accepted: 02/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The primary aim was to determine to what extent referral and admission of burn patients to a hospital with or without a burn center was in line with the EMSB referral criteria. METHODS This was a retrospective, multicenter cohort study. Burn patients admitted from 2014 to 2018 to a hospital in the Southwest Netherland trauma region and Network Emergency Care Brabant were included in this study. Outcome measures were the adherence to the EMSB referral criteria. RESULTS A total of 1790 patients were included, of whom 951 patients were primarily presented to a non-burn center. Of these patients, 666 (70.0%) were managed according to the referral criteria; 263 (27.7%) were appropriately not referred, 403 (42.4%) were appropriately referred. Twenty (2.1%) were overtransferred, and 265 (27.9%) undertransferred. In 1213 patients treated at a burn center 1119 (92.3%) met the referral criteria. Adherence was lowest for electrical (N = 4; 14.3%) and chemical burns (N = 16; 42.1%), and was highest in 'children ≥5% total body surface area (TBSA) burned' (N = 109; 83.2%). CONCLUSION The overall adherence to the referral criteria of patients presented to a non-burn center was fairly high. However, approximately 25% was not transferred to a burn center while meeting the criteria. Most improvement for individual criteria can be achieved in patients with electrical and chemical burns.
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Silvestre Salvador JF, Heras Mendaza F, Hervella Garcés M, Palacios-Martínez D, Sánchez Camacho R, Senan Sanz R, Apellaniz González A, Giménez-Arnau AM. Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. Actas Dermosifiliogr (Engl Ed) 2021; 111:26-40. [PMID: 32197684 DOI: 10.1016/j.ad.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/07/2019] [Revised: 04/11/2019] [Accepted: 04/21/2019] [Indexed: 12/28/2022] Open
Abstract
Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.
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Affiliation(s)
| | - F Heras Mendaza
- Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Hervella Garcés
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - D Palacios-Martínez
- Medicina de Atención Primaria, Centro de Salud Isabel II, Parla, Madrid, España
| | | | - R Senan Sanz
- Equipo de Atención Primaria el Clot, Instituto Catalán de la Salud, Barcelona, España
| | - A Apellaniz González
- Departamento de Estomatología, Facultad de Medicina y Enfermería, Euskal Herriko Unibertsitatea-Universidad del País Vasco, Leioa, Bizkaia, España
| | - A M Giménez-Arnau
- Departamento de Dermatología, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, España
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Montagnani C, Venturini E, L'Erario M, Tersigni C, Bortone B, Bianchi L, Menegazzo F, Indolfi G, Chiappini E, Galli L. Criteria for referral of pediatric SARS-CoV-2 infection: a real-life experience in the pandemic era. Ital J Pediatr 2020; 46:181. [PMID: 33287859 PMCID: PMC7720782 DOI: 10.1186/s13052-020-00946-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022] Open
Abstract
A practical guidance on the management of children with COVID-19 to insure homogeneous criteria for referral to a higher-level facility, according to the disease severity, is pivotal in the pandemic era. A panel of experts in pediatric infectious diseases and intensive care at the tertiary-care Meyer Children’s University Hospital, Florence, Italy, issued a practical document shared with Tuscany hospitals. The rationale was to target the referral for those children at risk of requiring an intensive support, since the above mentioned hospital has the pediatric intensive care unit. Overall, 378 patients between 0 and 19 years of age were diagnosed with COVID-19 infection in the Tuscany region with 24 (6.3%) hospitalizations. Only three children were centralized to Meyer Children’s University Hospital according to reported criteria. Considering that appropriate referral criteria have been associated with reduced mortality in other conditions, our document might be useful to improve outcomes of children with COVID-19.
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Affiliation(s)
- Carlotta Montagnani
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Manuela L'Erario
- Intensive Care Unit, Meyer Children's University Hospital, Florence, Italy
| | - Chiara Tersigni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Barbara Bortone
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | - Leila Bianchi
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy
| | | | - Giuseppe Indolfi
- Paediatric and Liver Unit, Meyer Children's University Hospital, Florence, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, University of Florence, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's University Hospital, Florence, Italy. .,Department of Health Sciences, University of Florence, Florence, Italy.
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Caraceni A, Lo Dico S, Zecca E, Brunelli C, Bracchi P, Mariani L, Garassino MC, Vitali M. Outpatient palliative care and thoracic medical oncology: Referral criteria and clinical care pathways. Lung Cancer 2019; 139:13-17. [PMID: 31704278 DOI: 10.1016/j.lungcan.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/05/2019] [Accepted: 10/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Recent evidences show that early integration of palliative care (PC) with oncology has a positive impact on patients' quality of life, quality of care and costs. However, there is no consensus on outpatient referral criteria. Based on real world data, the aim of this study was to identify timing and factors associated to PC referral in patients with thoracic malignancies, and to describe their clinical care pathway. MATERIAL AND METHODS This observational retrospective study included consecutive patients with thoracic cancer, seen for the first time at the Thoracic Medical Oncology outpatient Clinic (TMOC) of our institution, between Jan.01-Dec.31 2014. Patients were followed-up till death or Dec.31 2015. Clinical and demographic data were collected from the electronic patient records. Cox regression models were used to evaluate the association between time to Palliative care Outpatient Clinic (POC) referral and performance status (PS), disease stage and symptoms at inclusion. RESULTS 229 patients were eligible. 98 of them (43%; 95%IC 36%-49%) were referred to the POC within a median of 30 days (IQR 4-188). 80/98 patients received simultaneous anticancer therapy and PC. Univariable analysis showed that the hazard ratio (HR) of being referred to POC was significantly higher for patients with worse PS (HR = 4.5), more advanced disease stage (HR = 3.1), pain (HR = 4.9), dyspnea (HR = 2.5) and cough (HR = 2.2). The multivariable model confirmed independent prognostic value for PS, disease stage and pain. On Dec.31, 2015, 25/98 patients were still alive, 8 were lost at follow up and 65 had died. Among the latter, 61% died with hospice or home care, and, in the last 30 days of life, 16% received chemotherapy and 29% were admitted to hospital. CONCLUSIONS Our results suggest considering symptom burden, PS and disease stage as screening criteria for referral to PC in patients with thoracic malignancies.
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Affiliation(s)
- Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy; European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Paola Bracchi
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Milena Vitali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Žužek P, Rigler I, Podnar S. Validation of clinical criteria for referral to head imaging in the neurologic emergency setting. Neurol Sci 2019; 40:2541-8. [PMID: 31317350 DOI: 10.1007/s10072-019-04009-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In recent decades, diagnostic imaging became an important generator of large increases in medical spending. Inappropriate head CT referrals also increase population irradiation and unnecessarily burden and frighten patients. OBJECTIVE To validate previously proposed clinical criteria for referral to head imaging (age > 55 years, focal neurological deficit, changed mental state, nausea or vomiting, coagulation disorder, cancer) in a setting of emergency neurological service. METHODS We retrospectively analyzed electronic records of 500 consecutive referrals to neurological emergency and 500 referrals to emergency head imaging. In patients with several referrals, only results of the first evaluation were further analyzed. We calculated relations between clinical predictors, referrals, and findings of head imaging. RESULTS Of 486 first referrals of consecutive patients, 216 (44%) were referred to the emergency, and 100 (21%) to non-emergency head imaging. Remaining 170 (35%) were not referred to head imaging. Clinical predictors of pathologic head imaging fulfilled 77%, 41%, and 43% of patients, respectively. Pathologic head imaging had 153 of 490 (31%) referred patients. Referral criteria fulfilled 146 (sensitivity 95%) of them. Intracranial pathology was found in 7 of 125 patients not fulfilling referral criteria (negative predictive value 94%): 3 reported transient neurological symptoms, 2 sudden headache, and 2 headache with nausea and vomiting. CONCLUSION We confirmed utility of previously proposed clinical criteria for referral to head CT in emergency neurological setting. In addition, we found transient neurological symptoms, sudden severe headache, and headache with nausea or vomiting as additional independent indications for emergency head imaging.
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Luo G, Yuan Z, Peng Y, Huang Y, Wu J; Chinese Burn Association., Society of Burn Surgery of Chinese Medical Doctor Association., Editorial Committee of Chinese Journal of Burns., Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare., Burn and Trauma Branch of Chinese Geriatrics Society. [Chinese burn referral criteria (2018 version)]. Zhonghua Shao Shang Za Zhi 2018; 34:759-60. [PMID: 30481913 DOI: 10.3760/cma.j.issn.1009-2587.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is no national referral criteria for burns in China till now, which brings inconvenience and confusion. Based on the oversea experiences and the actual situation in China, many famous experts in burns discussed and developed this Chinese burn referral criteria (2018 version). We hope these referral criteria will be helpful in clinical practice of burns and can be improved continuously through application.
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Luo GX, Yuan ZQ, Peng YZ, Wu J, Huang YS. [Chinese burn referral criteria (2018 version)]. Zhonghua Shao Shang Za Zhi 2018; 34:E001. [PMID: 30440143 DOI: 10.3760/cma.j.issn.1009-2587.2018.11.e001] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is no national referral criteria for burns in China till now, which brings inconvenience and confusion. Based on the oversea experiences and the actual situation in China, many famous experts on burns discussed and developed this Chinese burn referral criteria (2018 version). We hope these referral criteria will be helpful in clinical practice in burn field and can be improved continuously during application.
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Affiliation(s)
| | | | | | | | | | - G X Luo
- 400038 Chongqing, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, the First Affiliated Hospital of Army Medical University (the Third Military Medical University)
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Lukmanji S, Altura KC, Rydenhag B, Malmgren K, Wiebe S, Jetté N. Accuracy of an online tool to assess appropriateness for an epilepsy surgery evaluation-A population-based Swedish study. Epilepsy Res 2018; 145:140-4. [PMID: 30007238 DOI: 10.1016/j.eplepsyres.2018.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/06/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The Canadian Appropriateness of Epilepsy Surgery (CASES) tool was developed to help physicians identify patients who should be referred for an epilepsy surgery evaluation. The aim of this study was to determine the accuracy of this tool using a population-based cohort registry (the Swedish National Epilepsy Surgery Register) of patients who underwent epilepsy surgery between 1990 and 2012. METHODS Overall, 1044 patients met eligibility criteria for the study and were deemed to be surgical candidates by epilepsy experts. Demographic and epilepsy related characteristics were examined and summarized using descriptive statistics. A CASES appropriateness score was calculated for each of these patients. Chi squared analyses or fisher's exact tests were used to determine if there were any relationships between demographic and epilepsy related characteristics not captured in the tool and appropriateness scores. RESULTS The mean appropriateness score was 8.6 and 985 (Sensitivity: 94.35%; 95% CI, 92.77%-95.60%) patients were appropriate, 46 (4.41%; 95% CI, 3.31%-5.84%) were uncertain, and 13 (1.25%; 95% CI, 0.72%-2.13%) were inappropriate for an epilepsy surgery evaluation. The mean necessity score, which was only calculated for the 985 appropriate patients, was 8.7. All 13 inappropriate patients had tried less than two anti-epileptic drugs (AEDs). In addition, age at onset of epilepsy and age at epilepsy surgery were both significantly associated with appropriateness score. CONCLUSIONS These results demonstrate that the CASES tool is highly sensitive as it designated 94.3% of epilepsy surgery patients as appropriate for an epilepsy surgery evaluation. All of those classified as inappropriate were not drug resistant, as they had not yet tried two AEDs.
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Abstract
Pakistan is a developing country with limited resources and diverse socio-economic standards. Pakistan has high prevalence of diabetes and its complications, which is a great challenge to the existing health care system. National action plans for control of diabetes have been developed and initiatives have been taken but not at an ideal pace. First National Practice Guidelines for Pakistan were published in 1999. It was very helpful in standardizing the management of Type-2 diabetes. In view of important developments in the field of diabetes during the recent years, it was felt that 1999 National Clinical Practice Guidelines edited, should be revised. Also with rapidly increasing number of diabetic patients and the escalating burden on health economy, it is essential to develop a primary to secondary / tertiary care referral system. These guidelines are developed after an extensive research and cover many aspects of diabetes management. This special communication is an extract of a PROMPT document that has already been published as a Supplement in Pakistan Journal of Medical Sciences in 2017. We hope that these guidelines will help in improving the diabetes care in Pakistan.
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Affiliation(s)
- A Samad Shera
- A Samad Shera, FRCP. Honorary President (IDF), Secretary General (DAP), Director, WHO Collaborating Centre. Diabetic Association of Pakistan
| | - Abdul Basit
- Prof. Abdul Basit, FRCP. Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
| | - Prompt Team
- PROMPT Team, FRCP. Department of Medicine, Baqai Institute of Diabetology and Endocrinology, Baqai Medical University, Karachi, Pakistan
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Klingberg A, Wallis L, Rode H, Stenberg T, Laflamme L, Hasselberg M. Assessing guidelines for burn referrals in a resource-constrained setting: Demographic and clinical factors associated with inter-facility transfer. Burns 2017; 43:1070-1077. [PMID: 28420571 DOI: 10.1016/j.burns.2017.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 11/15/2022]
Abstract
AIM The aim was to assess demographic and clinical factors associated with inter-facility referrals for patients with burns in a resource-constrained setting. METHODS This was a cross-sectional case review of patients presenting with a burn at the trauma unit at the Red Cross War Memorial Children's Hospital (RXH) in Cape Town, South Africa. RESULTS Six hundred and eleven-(71%) children were referred to the burns or the intensive care unit and 253 children were treated and discharged from the trauma unit. Of those admitted as inpatients 94% fulfilled at least one of the criteria for referral and 80% of those treated and discharged fulfilled the criteria for referral. CONCLUSIONS Almost three out of four children evaluated at the trauma unit were referred to the burns unit for further management. However, a large number of patients were treated and discharged from the trauma unit despite being eligible for referral.
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Affiliation(s)
- A Klingberg
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden.
| | - L Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Private Bag X24, Bellville 7535, South Africa
| | - H Rode
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Stenberg
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
| | - L Laflamme
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden; University of South Africa, Preller Street, Pretoria 0002, South Africa
| | - M Hasselberg
- Department of Public Health Sciences, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18 A, 171 77 Stockholm, Sweden
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van der Zee YJ, Stiers P, Evenhuis HM. Should we add visual acuity ratios to referral criteria for potential cerebral visual impairment? J Optom 2017; 10:95-103. [PMID: 26896051 PMCID: PMC5383453 DOI: 10.1016/j.optom.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 12/24/2015] [Accepted: 01/16/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine whether the assessment of visual acuity ratios might improve the referral of children with (sub)normal visual acuity but at risk of cerebral visual impairment. METHODS In an exploratory study, we assessed visual acuity, crowding ratio and the ratios between grating acuity (Teller Acuity Cards-II) and optotype acuity (Cambridge Crowding Cards) in 60 typically developing school children (mean age 5y8m±1y1m), 21 children with ocular abnormalities only (5y7m±1y9m) and 26 children with (suspected) brain damage (5y7m±1y11m). Sensitivities and specificities were calculated for targets and controls from the perspective of different groups of diagnosticians: youth health care professionals (target: children with any visual abnormalities), ophthalmologists and low vision experts (target: children at risk of cerebral visual impairment). RESULTS For youth health care professionals subnormal visual acuity had the best sensitivity (76%) and specificity (70%). For ophthalmologists and low vision experts the crowding ratio had the best sensitivity (67%) and specificity (79 and 86%). CONCLUSION Youth health care professionals best continue applying subnormal visual acuity for screening, whereas ophthalmologists and low vision experts best add the crowding ratio to their routine diagnostics, to distinguish children at risk of visual impairment in the context of brain damage from children with ocular pathology only.
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Affiliation(s)
- Ymie J van der Zee
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands; Royal Dutch Visio, Dutch Centre of Excellence for Visually Impaired and Blind People, The Netherlands.
| | - Peter Stiers
- Department of Neuropsychology & Psychopharmacology, University Maastricht, Maastricht, The Netherlands
| | - Heleen M Evenhuis
- Intellectual Disability Medicine, Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
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Rumbach AF, Clayton NA, Muller MJ, Maitz PKM. The speech-language pathologist's role in multidisciplinary burn care: An international perspective. Burns 2016; 42:863-71. [PMID: 26822697 DOI: 10.1016/j.burns.2016.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore international practices of speech-language pathology (SLP) within burn care in order to provide direction for education, training and clinical practice of the burns multidisciplinary team (MDT). METHOD(S) A 17-item online survey was designed by two SLPs experienced in burn care with a range of dichotomous, multiple choice and open-ended response questions investigating the availability and scope of practice for SLPs associated with burn units. The survey was distributed via professional burn association gatekeepers. All quantitative data gathered were analysed using descriptive statistics and qualitative data were analysed using content analysis. RESULT(S) A total of 240 health professionals, from 6 different continents (37 countries) participated within the study. All continents reported access to SLP services. Referral criteria for SLP were largely uniform across continents. The most dominant area of SLP practice was assessment and management of dysphagia, which was conducted in concert with other members of the MDT. CONCLUSION SLP has an international presence within burn care that is currently still emerging.
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Affiliation(s)
- Anna F Rumbach
- School of Health and Rehabilitation Sciences, Speech Pathology, The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia.
| | - Nicola A Clayton
- Speech Pathology Department & Burns Unit, Building 42, Hospital Rd, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia.
| | - Michael J Muller
- Stuart Pegg Adult Burns Centre, Level 4 James Mayne Building, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
| | - Peter K M Maitz
- Burns Unit, Level 7, Hospital Rd, Concord Repatriation General Hospital, Sydney, NSW 2139, Australia.
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Abstract
Pediatric palliative care (PPC) is a relatively new and quickly growing pediatric subspecialty. It is generally provided using a consultative model, and is available in most specialized pediatric hospitals. This article discusses PPC consultation with specific focus on the added value of PPC, elements of a PPC consultation, and challenges to and opportunities for PPC consultation. Ongoing research, current publication, expert opinion, and institutional experience were compiled for this article.
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Affiliation(s)
- Dominic Moore
- Division of In-Patient Medicine, Pediatrics, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Joan Sheetz
- Division of In-Patient Medicine, Pediatrics, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA.
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Rumbach AF, Ward EC, Heaton S, Bassett LV, Webster A, Muller MJ. Validation of predictive factors of dysphagia risk following thermal burns: a prospective cohort study. Burns 2014; 40:744-50. [PMID: 24176757 DOI: 10.1016/j.burns.2013.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/10/2013] [Accepted: 09/26/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE The objective of this study was to prospectively evaluate the validity and reliability of a risk factor model developed for use in predicting dysphagia risk within the first 24 h after injury/hospitalisation in patients with thermal burns. METHOD(S) Three hundred and fifty six patients with thermal burns, with or without inhalation injury, who were consecutively admitted to and received management at a quaternary state-wide burn center over a 12 month period, were included. Patients were reviewed for dysphagia risk by nursing staff using an established set of predictive factors. If risk factors for dysphagia were present, referral to speech-language pathology was initiated to investigate swallow function. RESULT(S) Of the 356 admissions, 83 patients were identified as meeting one or more risk criteria for dysphagia after burn. Of these, 24.9% (n = 30; 8.42% of the total cohort) presented with dysphagia. Using these criteria, sensitivity and specificity for detection of dysphagia risk were high (100% and 83.74%, respectively). The criteria over identify patients who may be at risk of dysphagia and who require dysphagia assessment (positive predictive value = 36.14%). However, as a set of predictors of dysphagia risk when thermal burn is the only complaint, a negative result reassures that a patient does not have dysphagia (negative predictive value = 100%). CONCLUSION Overall, the risk factor model provided a valid measure for predicting dysphagia risk. Incorporating these criteria into a dysphagia screening assessment can ensure an evidence-based pathway for early detection and timely referral to speech-language pathology for patients at risk of dysphagia after thermal burns.
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McCoubrey A, Warren C, McAllister I, Gilliland R. Is the "red flag" referral pathway effective in diagnosing colorectal carcinoma? Ulster Med J 2012; 81:127-9. [PMID: 23620610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/08/2012] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In 2000-2004 there were, on average, 93 8 new cases of colorectal cancer (CRC) diagnosed per annum in Northern Ireland, accounting for 13.9% of all cancers. The two week "red flag" referral system aims to detect 90% of patients with CRC for prompt treatment. The aim of this study is to examine the impact of the "red flag" referral system on identification of patients with CRC, time to treatment and stage of disease. METHODS A random sample of 200 patients referred via the "red flag" system was identified from the local cancer patient tracker database. Data pertaining to demographics, time to hospital appointment, appropriateness of referral and diagnosis were collected. For patients identified with CRC, the stage of disease and time to first definitive treatment were also documented. RESULTS Of the 200 patients, 56% were female. The age range was 27-93 years. Eighty three percent were seen within 14 days of referral. Referrals adhered to the guidelines in 45% of cases. There were 4 pancreatic cancers, 1 endometrial cancer, 1 ovarian cancer and 1 myelodysplasia diagnosed. Three patients were diagnosed with CRC (1.5%). Of these, 1 was palliative and the remaining 2 commenced definitive management within 6 days of decision to treat. CONCLUSION The "red flag" referral system does not appear to be effective in identifying patients with CRC but did identify patients with other types of cancer. Less than half of the referrals adhered to the guidelines. A review of this system should be undertaken.
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