scholarly journals Comparison between melanoma diagnostic pathways and access to services for rural versus metropolitan patients during Victoria’s COVID‐19 lockdown

2021 ◽  
Author(s):  
Katrina Tan ◽  
Yan Pan ◽  
Victoria Mar
Keyword(s):  
Access To Services ◽  
Diagnostic Pathways

International Telesupervision: The Clinical Fellowship Experience

2017 ◽  
Vol 2 (11) ◽  
pp. 73-78
Author(s):  
David W. Rule ◽  
Lisa N. Kelchner
Keyword(s):  
Graduate Students ◽  
Clinical Supervision ◽  
Rural Areas ◽  
The United States ◽  
Speech Language Pathology ◽  
Access To Services ◽  
East African ◽  
The World ◽  
Language Pathology ◽  
National Certification

Telepractice technology allows greater access to speech-language pathology services around the world. These technologies extend beyond evaluation and treatment and are shown to be used effectively in clinical supervision including graduate students and clinical fellows. In fact, a clinical fellow from the United States completed the entire supervised clinical fellowship (CF) year internationally at a rural East African hospital, meeting all requirements for state and national certification by employing telesupervision technology. Thus, telesupervision has the potential to be successfully implemented to address a range of needs including supervisory shortages, health disparities worldwide, and access to services in rural areas where speech-language pathology services are not readily available. The telesupervision experience, potential advantages, implications, and possible limitations are discussed. A brief guide for clinical fellows pursuing telesupervision is also provided.

Housing Matters, Services Might: Findings from the High Needs Families Program Evaluation

2021 ◽  
Vol 693 (1) ◽  
pp. 209-229
Author(s):  
Debra J. Rog ◽  
Kathryn A. Henderson ◽  
Clara A. Wagner ◽  
Emily L. Abbruzzi
Keyword(s):  
Support Services ◽  
Justice System ◽  
Subsidized Housing ◽  
Supportive Housing ◽  
Intensive Case Management ◽  
Access To Services ◽  
Supportive Services ◽  
Housing Stability ◽  
The Past ◽  
Permanent Supportive Housing

Permanent supportive housing for families experiencing homelessness—typically, subsidized housing that is not time limited and provides access to a range of support services—has substantially increased over the past 10 years, despite an absence of rigorous evidence of its effectiveness. We examine the benefits of subsidized housing with supportive services compared to subsidized housing alone. Our findings suggest that supportive housing offers more opportunities for access to services and benefits than subsidized housing alone, but it may not be beneficial to families’ housing stability or to family members’ employment or involvement with the criminal justice system. We argue that housing that is coupled with intensive case management, that is service rich, and that provides and adheres to harm reduction principles may help to strengthen supportive housing’s effectiveness.

scholarly journals 92 Reshaping the Diagnostic Pathways for Investigation of Haematuria During and After The COVID-19 Pandemic: Diagnostic Accuracy of Strategies for Detection of Bladder Cancer from The IDENTIFY Cohort Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Khadhouri ◽  
K Gallagher ◽  
K MacKenzie ◽  
T Shah ◽  
C Gao ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cohort Study ◽  
Test Performance ◽  
Bladder Tumour ◽  
Healthcare Services ◽  
Diagnostic Strategies ◽  
Flexible Cystoscopy ◽  
Resource Limited ◽  
Diagnostic Test Performance ◽  
Diagnostic Pathways

Abstract Introduction Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway. Method The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway. Results 8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer. Conclusions We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

scholarly journals Modelling lung cancer diagnostic pathways using discrete event simulation

2021 ◽  
pp. 1-11
Author(s):  
Tracey England ◽  
Paul Harper ◽  
Tom Crosby ◽  
Daniel Gartner ◽  
Edilson F. Arruda ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Discrete Event Simulation ◽  
Discrete Event ◽  
Event Simulation ◽  
Cancer Diagnostic ◽  
Diagnostic Pathways

807 Diagnostic Pathways of Patients Authorized for Obstructive Sleep Apnea Testing and Treatment: A Retrospective Claims Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A315-A315
Author(s):  
Binh Nguyen ◽  
Aliza Gordon ◽  
Stefanida Blake ◽  
Lakshmi Kalluri ◽  
Winnie Chi ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Laboratory Testing ◽  
Diagnostic Testing ◽  
Prior Authorization ◽  
Home Test ◽  
Home Testing ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
Diagnostic Pathways ◽  
Lab Test

Abstract Introduction Obstructive Sleep Apnea (OSA) has been shown to reduce health-related quality of life and is associated with cardiovascular disease and other negative health outcomes. However, many patients with suspected OSA are never tested, thereby remaining undiagnosed and untreated. In this study, we explore the diagnostic pathways and eventual treatment of individuals with suspected OSA. Methods We conducted a retrospective, observational study, linking claims and prior authorization data of a large, geographically diverse health insurer’s commercial and Medicare Advantage members. Our sample included adults with suspected OSA and no prior OSA history, whose diagnostic testing had been approved through prior authorization (N=75,011). Using a 3-month time window following authorization, we searched for a claim to match the authorized service (home or laboratory sleep testing). We also looked for subsequent prior authorization for OSA treatment (Positive Airway Pressure (PAP) or oral appliance) and corresponding claims for those treatments within the 3-month authorization window. Results Among the study sample (N=75,011), 40,002 (53.3%) had home testing only, 17,319 (23.1%) had laboratory testing only, and 6,053 (8.1%) had a home test followed by a laboratory test. Only 476 (0.6%) had a home test after the date of a lab test. 11,161 individuals (14.9%) did not complete any sleep test. Of the 63,850 individuals with any sleep testing, 39,062 (61.2%) received prior authorization for initiating OSA treatment, and 36,158 (92.6%) of them had a corresponding claim for treatment. Conclusion One in eight adults with suspected OSA for whom diagnostic testing was authorized did not undergo testing; among those who tested, home testing was most common. While it is clinically appropriate to follow a negative home test with a lab test since a home test cannot rule out OSA (only confirm it), the study notes that a significant number of those with a home test require follow-up laboratory testing. Together, this represents an opportunity for reducing barriers to testing and improvement in home testing technology. Support (if any) This study was funded by Anthem, Inc.

scholarly journals The PATHFINDER Study: Assessment of the Implementation of an Investigational Multi-Cancer Early Detection Test into Clinical Practice

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3501
Author(s):  
Lincoln D. Nadauld ◽  
Charles H. McDonnell ◽  
Tomasz M. Beer ◽  
Minetta C. Liu ◽  
Eric A. Klein ◽  
...  
Keyword(s):  
Early Detection ◽  
Test Performance ◽  
Primary Objective ◽  
Diagnostic Evaluation ◽  
Cancer Risk Factors ◽  
Cancer Early Detection ◽  
Diagnostic Resolution ◽  
Multi Center Study ◽  
Diagnostic Pathways ◽  
Prospective Longitudinal

To examine the extent of the evaluation required to achieve diagnostic resolution and the test performance characteristics of a targeted methylation cell-free DNA (cfDNA)-based multi-cancer early detection (MCED) test, ~6200 participants ≥50 years with (cohort A) or without (cohort B) ≥1 of 3 additional specific cancer risk factors will be enrolled in PATHFINDER (NCT04241796), a prospective, longitudinal, interventional, multi-center study. Plasma cfDNA from blood samples will be analyzed to detect abnormally methylated DNA associated with cancer (i.e., cancer “signal”) and a cancer signal origin (i.e., tissue of origin). Participants with a “signal detected” will undergo further diagnostic evaluation per guiding physician discretion; those with a “signal not detected” will be advised to continue guideline-recommended screening. The primary objective will be to assess the number and types of subsequent diagnostic tests needed for diagnostic resolution. Based on microsimulations (using estimates of cancer incidence and dwell times) of the typical risk profiles of anticipated participants, the median (95% CI) number of participants with a “signal detected” result is expected to be 106 (87–128). Subsequent diagnostic evaluation is expected to detect 52 (39–67) cancers. The positive predictive value of the MCED test is expected to be 49% (39–58%). PATHFINDER will evaluate the integration of a cfDNA-based MCED test into existing clinical cancer diagnostic pathways. The study design of PATHFINDER is described here.

scholarly journals CASPA (CArdiac Sarcoidosis in PApworth) improving the diagnosis of cardiac involvement in patients with pulmonary sarcoidosis: protocol for a prospective observational cohort study

2020 ◽  
Vol 7 (1) ◽  
pp. e000608
Author(s):  
Juan Carlos Quijano-Campos ◽  
Lynne Williams ◽  
Sharad Agarwal ◽  
Katharine Tweed ◽  
Robert Parker ◽  
...  
Keyword(s):  
Speckle Tracking ◽  
Cardiac Sarcoidosis ◽  
Serum Proteins ◽  
High Resolution Mass Spectrometry ◽  
Holter Monitoring ◽  
Pulmonary Sarcoidosis ◽  
Multisystem Disease ◽  
Positron Emission ◽  
Integrated Research ◽  
Diagnostic Pathways

IntroductionSarcoidosis is a multisystem disease, predominantly affecting the lungs but can involve the heart, resulting in cardiac sarcoidosis (CS). Patients require MRI/Positron Emission Tomography (PET) scans for diagnosis. Echocardiography, ECG and Holter monitoring may be indicative but not diagnostic alone. Patients can present late with conduction defects, heart failure or sudden death. The CASPA (CArdiac Sarcoidosis in PApworth) study protocol aims to (1) use MRI to identify CS prevalence; (2) use speckle-tracking echocardiography, signal averaged ECG and Holter monitoring to look for diagnostic pathways; and (3) identify serum proteins which may be associated with CS.Methods and analysisParticipants with pulmonary sarcoidosis (and no known cardiac disease) from Royal Papworth Hospital will have the following: cardiac MRI with late gadolinium, two-dimensional transthoracic echocardiography with speckle tracking, signal averaged ECG and 24-hour Holter monitor. They will provide a serum sample for brain natriuretic peptide levels and proteomics by liquid chromatography coupled to high-resolution mass spectrometry. All data will be collected on OpenClinica platform and analysed approximately 6 months after final patient recruitment.Ethics and disseminationThe Camden & Kings Cross Research Ethics Committee approved the protocol (REC number: 17/LO/0667). Integrated Research Approval System (IRAS) 222 720. Dissemination of findings will be via conference presentations and submitted to peer-reviewed journals.

Diagnostic Pathways and Clinical Significance of Desquamative Gingivitis

2008 ◽  
Vol 79 (1) ◽  
pp. 4-24 ◽  
Author(s):  
Lucio Lo Russo ◽  
Stefano Fedele ◽  
Rosario Guiglia ◽  
Domenico Ciavarella ◽  
Lorenzo Lo Muzio ◽  
...  
Keyword(s):  
Clinical Significance ◽  
Diagnostic Pathways
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