scholarly journals Delay in diagnosis of patients with head-and-neck cancer in Canada: impact of patient and provider delay

2020 ◽  
Vol 27 (5) ◽  
Author(s):  
S. Kassirian ◽  
A. Dzioba ◽  
S. Hamel ◽  
K. Patel ◽  
D.A. Palma ◽  
...  
Keyword(s):  
Health Care ◽  
Head And Neck ◽  
Demographic Data ◽  
Tertiary Care ◽  
Wait Time ◽  
Late Presentation ◽  
Initial Symptom ◽  
Anatomic Site ◽  
Delay In Diagnosis ◽  
First Time

Background Head-and-neck cancers (hncs) often present at an advanced stage, leading to poor outcomes. Late presentation might be attributable to patient delays (reluctance to seek treatment, for instance) or provider delays (misdiagnosis, prolonged wait time for consultation, for example). The objective of the present study was to examine the length and cause of such delays in a Canadian universal health care setting. Methods Patients presenting for the first time to the hnc multidisciplinary team (mdt) with a biopsy-proven hnc were recruited to this study. Patients completed a survey querying initial symptom presentation, their previous medical appointments, and length of time between appointments. Clinical and demographic data were collected for all patients. Results The average time for patients to have their first appointment at the mdt clinic was 15.1 months, consisting of 3.9 months for patients to see a health care provider (hcp) for the first time since symptom onset and 10.7 months from first hcp appointment to the mdt clinic. Patients saw an average of 3 hcps before the mdt clinic visit (range: 1–7). No significant differences in time to presentation were found based on stage at presentation or anatomic site. Conclusions At our tertiary care cancer centre, a patient’s clinical pathway to being seen at the mdt clinic shows significant delays, particularly in the time from the first hcp visit to mdt referral. Possible methods to mitigate delay include education about hnc for patients and providers alike, and a more streamlined referral system.

scholarly journals A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

CJEM ◽  
2016 ◽  
Vol 19 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Jacqueline Fraser ◽  
Paul Atkinson ◽  
Audra Gedmintas ◽  
Michael Howlett ◽  
Rose McCloskey ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Performance Indicator ◽  
Medical Condition ◽  
Demographic Data ◽  
Family Doctor ◽  
Wait Time ◽  
Wait Times ◽  
Control Group ◽  
Fisher Exact Test

AbstractObjectiveThe emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.MethodsWe collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.ResultsThe LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).ConclusionLWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.

A Study on Cytomorphological and Histopathological Correlation of Head and Neck Lesions in a Tertiary Care Centre, Bhubaneswar, Odisha

2021 ◽  
Vol 8 (33) ◽  
pp. 3104-3109
Author(s):  
Anima Hota ◽  
Pranita Mohanty ◽  
Mitu Mohanty
Keyword(s):  
Head And Neck ◽  
Care Center ◽  
Tertiary Care ◽  
Malignant Lesion ◽  
Tertiary Care Centre ◽  
Anatomic Site ◽  
Histopathological Findings ◽  
Statistical Measures ◽  
Neoplastic Lesions ◽  
Thyroid Lesions

BACKGROUND The head and neck region is an anatomic site having lymph nodes, nerves, veins, arteries, muscles, mucosal epithelium to salivary glands, thyroid, and a host of developmental tissues. Any of these tissues can become pathological, resulting in a mass. Fine needle aspiration cytology (FNAC) is regarded as a reliable method of investigation in diagnosis of head and neck lesions. However, histopathology is the gold standard of diagnosis. The purpose of this study was to assess the frequency of head and neck tumours according to the sites of their occurrence and to find out the correlation of cytopathological findings by FNAC and histopathological findings by biopsy. METHODS This prospective study undertaken from June 2012 to June 2014 in the Department of Pathology, IMS and SUM Hospital, Bhubaneswar, a tertiary care center. All the patients attending different outdoor of IMS & SUM Hospital, Bhubaneswar with head & neck lesions referred for FNAC were included in the study. The results of FNAC were compared with that of histopathological findings by tissue biopsy. Data collected was entered in MS Excel and analysed using the same software. Descriptive statistical measures like frequency and percentage. Data was presented in tabular form. RESULTS The commonest site of lesion was in the lymph node followed by thyroid gland. There was preponderance of female sex in thyroid lesions whereas males were commonest in other sites. The accuracy in cyto-histopathology correlation between benign and malignant lesion was 96.36 % and 88.89 % respectively and was most corroborated in the thyroid lesions (50.6 %). CONCLUSIONS Cyto-histo correlation of head and neck lesions provides an important, quick, excellent, and sensitive diagnostic tool to exclude non-neoplastic lesions from neoplastic lesions. KEYWORDS Head and Neck Lesions, FNAC, Histopathology

Nosocomial Infection With Cephalosporin-ResistantKlebsiella pneumoniaeIs Not Associated With Increased Mortality

2006 ◽  
Vol 27 (9) ◽  
pp. 907-912 ◽  
Author(s):  
Cristiana C. Gomes ◽  
Evangelina Vormittag ◽  
Cleide R. Santos ◽  
Anna S. Levin
Keyword(s):  
Odds Ratio ◽  
Demographic Data ◽  
Tertiary Care ◽  
Study Drug ◽  
Underlying Disease ◽  
University Hospital ◽  
Third Generation ◽  
Anatomic Site ◽  
Irreversible Damage ◽  
Third Generation Cephalosporins

Objective.To evaluate whether resistance to third-generation cephalosporins and/or aztreonam was associated with a higher mortality rate among patients with nosocomialKlebsiella pneumoniaeinfections.Design.Retrospective cohort study.Setting.Tertiary care university hospital.Methods.A total of 143 patients with nosocomial infections due toK. pneumoniaewere evaluated. Death within 21 days after diagnosis of infection was the outcome. Demographic data, invasive procedures, presence and severity of underlying conditions, infection diagnosis, anatomic site of isolation, and treatment of infection, as well as resistance to third-generation cephalosporins and/or aztreonam, were evaluated for association with the outcome.Results.The mortality associated with nosocomialK. pneumoniaeinfections was 22% in our study. Drug resistance was found in isolates from 48% of case patients. Multivariate analysis demonstrated that the severity of the patient's underlying condition (odds ratio, 12.50;P<.01) and isolation of the microorganism from the blood or from another usually sterile site (odds ratio, 2.94;P= .03) were associated with death. On the other hand, the presence of resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. When only the severe cases of infection were analyzed, the results were unchanged.Conclusions.Resistance to cephalosporins and/or aztreonam did not affect mortality, and the use of inadequate treatment was not significantly associated with increased mortality. The reasons for this are not clear. It is possible that the severity of the underlying disease and the patient's condition have a larger role than theK. pneumoniaeinfection in determining the outcome, and initially inadequate treatment may not have an impact sufficient to cause irreversible damage, allowing treatment to be changed to an effective drug.

scholarly journals Prevalence of obesity and diabetes among health care physicians in Pondicherry, India

2019 ◽  
Vol 6 (3) ◽  
pp. 646
Author(s):  
Sethu Prabhu Shankar ◽  
E. Uma Sudhan ◽  
K. Harsha Vardhan Reddy ◽  
Rahul Singh ◽  
Neelakandan Ramya
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Demographic Data ◽  
Tertiary Care ◽  
Care Hospital ◽  
Adult Health ◽  
Female Physicians ◽  
Family History Of Diabetes ◽  
Obesity And Diabetes ◽  
Prevalence Of Obesity

Background: Non communicable diseases like obesity and diabetes are increasing worldwide, healthcare physicians are also not immune to this morbidity. The objective of this study is to find the prevalence of obesity and diabetes among healthcare physicians.Methods: The study was done at a tertiary care hospital in Pondicherry. All adult health care physicians of both sexes working in the hospital and giving informed consent to participate in the study were included. Pregnant physicians and those who are not willing to give written consent for participation in the study were excluded from the study. The study was done as a cross sectional study using a pretested standardized questionnaire. Age, sex, demographic data, height, weight, diet habits, family history of diabetes, exercise, medication in all the health care physicians were recorded and studied.Results: Of the total one hundred health care physicians, there were 50 male and 50 female physicians. Among the female physicians, there were 17 of age 41 to 50 years. There were 27 male and 34 female physicians with body mass index of 25 to 29.9. Six males and four females had diabetes mellitus. Six physicians were doing regular exercise. Four physicians were taking both oral anti hyperglycemic drugs and insulin.Conclusions: Doctors are aware and educated part of the society but there is high prevalence of obesity and diabetes mellitus among healthcare physicians. Doctor have to be motivated to take care of their health and to prevent lifestyle disease complication. Further regular screening for diabetes and obesity has to be done for doctors.

scholarly journals COVID-19 Health Care for Afghan Refugees as a Minor Ethnicity in Iran; Clinical Differences and Racial Equality in Health

2021 ◽  
Author(s):  
Navid Kalani ◽  
Naser Hatami ◽  
Marzieh Haghbeen ◽  
Uzair Yaqoob ◽  
Esmaeil Raeyat Doost
Keyword(s):  
Health Care ◽  
Racial Inequality ◽  
Demographic Data ◽  
Control Group ◽  
Case Group ◽  
Initial Symptom ◽  
Afghan Refugees ◽  
Significant Difference ◽  
Iranian Patients ◽  
Icu Treatment

The aim of this research was to look at the clinical differences between Afghan refugees and the Iranian community, as well as the evaluation of healthcare inequalities against Afghan refugees. ‎This was a 1:2 matched case-control study carried out at two tertiary hospitals of Jahrom city, southern Iran, from January 2020 to December 2020. Cases were COVID-19 infected Afghans, and controls were Iranian patients. Demographic data, Self-reported symptoms, disease history, and initial symptom to referral length were extracted from medical records. CT scans being conducted and receiving ICU treatment were assessed for evaluation of racial inequality in health care. In this study, 132 Afghan refugees were compared to 266 Iranian controls. There were multiple self-reported symptoms being statistically differently manifested in Afghan refugees in comparison to Iranian COVID-19 patients. There was no difference in probability of being evaluated by HRCT or receiving ICU treatment (P=0.173, 1, respectively) even after being adjusted for symptoms or co-morbidities that were manifesting differently between Afghan vs. Iranian patients (P=0.476, 0.881, respectively). Ten (7.57%) subjects died in the case group and 18 (6.76) in the control group. There wasn’t any significant difference in the death rate between the groups (P=0.766). Our study revealed huge differences in symptoms of Afghan vs. Iranian COVID-19 patients, while these differences did not affect the probability of receiving proper health care. Jahrom city was a case of equality in COVID-19 health care toward the ethnic minorities.

scholarly journals Pattern of physical activity, diet, sleep and yoga in health care physicians. A study from a tertiary care hospital, Pondicherry

2017 ◽  
Vol 4 (5) ◽  
pp. 1394
Author(s):  
Sethu Prabhu Shankar ◽  
Neelakandan Ramya
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Abdominal Obesity ◽  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Cardiovascular Fitness ◽  
Care Hospital ◽  
Female Physicians ◽  
Diet Habits

Background: Physical activity, diet pattern and yoga practices are linked with cardiovascular fitness. The objective of this study is to study the pattern of physical activity, diet and yoga practice in health care physicians.Methods: The study was done at a tertiary care hospital in Pondicherry. All adult health care physicians of both sexes working in the hospital and giving informed consent to participate in the study were included. Pregnant physicians and those who are not willing to give written consent for participation in the study were excluded from the study. The study was done as a cross sectional study using a pretested standardised questionnaire. Age, sex, demographic data, height, weight, diet habits, pattern of physical activity, sleep and yoga pattern in all the health care physicians were recorded and studied.Results: Of the total one hundred health care physicians, there were 65 male physicians. Among the female physicians, there were 20 of age 31 to 40 years, Of the 65 male physicians, there were 28 with body mass index of 25 to 29.9. Eight males and four females in the age group of 41 to 50 had abdominal obesity. Eight female physicians were doing regular exercise and nine physicians were doing yoga.Conclusions: They had a poor physical activity pattern, improper diet habits and reduced sleep. Only a few physicians were having the practice of doing yoga. Overweight and abdominal obesity was more prevalent in health care physicians.

scholarly journals Analysis of causes for late presentation of Indian patients with vestibular schwannoma

2008 ◽  
Vol 123 (5) ◽  
pp. 502-508 ◽  
Author(s):  
R Ambett ◽  
V Rupa ◽  
V Rajshekhar
Keyword(s):  
Vestibular Schwannoma ◽  
Delayed Diagnosis ◽  
Final Diagnosis ◽  
Late Presentation ◽  
Definitive Diagnosis ◽  
Initial Symptom ◽  
Related Factors ◽  
Delay In Diagnosis ◽  
Indian Patients ◽  
A Prospective Study

AbstractObjective:To determine the causes of delay in diagnosis and treatment of Indian patients with vestibular schwannomas.Methods:In a prospective study from 2003 to 2005, 50 patients with a confirmed diagnosis of vestibular schwannoma were interviewed to determine the causes for (1) the delay between the patient noting the initial symptom and the definitive diagnosis, and (2) the reasons for delayed diagnosis.Results:In 90 per cent of patients, the initial symptom was either hearing loss (62 per cent), vertigo (24 per cent) or tinnitus (4 per cent). However, most patients had been diagnosed and had presented for surgery only after neurological symptoms had became apparent. The delay between the initial medical consultation and the final diagnosis ranged from one month to 204 months (mean ± standard deviation, 32.2 ± 38.9 months). After the patient had noted symptoms, the diagnosis of vestibular schwannoma was delayed due to doctor-related causes in 80 per cent of cases, and due to patient-related causes in 20 per cent. Delay following diagnosis was minimal.Conclusions:Delay in the diagnosis of vestibular schwannoma in Indian patients is due to both doctor- and patient-related factors.

scholarly journals The Present Status of the Management of Colon and Rectal Cancer in Nigeria

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
David O. Irabor ◽  
O. Oludolapo Afuwape ◽  
Omobolaji O. Ayandipo
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Demographic Data ◽  
Tertiary Care ◽  
Late Presentation ◽  
Resected Specimen ◽  
Rapid Progression ◽  
Care Hospital ◽  
Female Ratio ◽  
Colon And Rectal Cancer

Aim. To demonstrate the possibility of the uniqueness of colorectal cancer (CRC) in the native Nigerian by looking at the different facets of the challenges that management of this disease presents in a tertiary-care hospital in Ibadan, Nigeria. Method. A cohort study starting in 2009 where patients were seen in the out-patient’s clinic. All patients who presented with features suggestive of colon or rectal cancer were studied. Biopsies were performed to confirm CRC (especially rectal cancer); patients were then booked for admission and subsequent operation. Patients were excluded if the histopathology of a resected or biopsied mass turned out to be noncancerous or inflammatory. Demographic data like age and sex were recorded. The type of operation done, findings at surgery, and the histopathology of the resected specimen were all recorded. The time taken for the pathology department to process the biopsy and resected specimens was also recorded. Results. 120 patients with CRC were seen over the study period of 5 years (2009–2013) giving an average of 24 patients per annum. The male : female ratio was 1 : 1.14. 86 (71.7%) patients had rectal cancer while the remaining 34 (28.3%) had colon cancer. Most of the colon cancer cases were in the 51–60 age group. The rectum : colon ratio was 2.5 : 1.31% of the patients were 40 years and below. 37% of those with rectal cancer were 40 years and below. 50% of resected specimens were Duke’s B and above. 45% of patients had tumors with unfavorable grade or biology (mucinous 21.7%, signet ring 8.3%, and poorly differentiated 15%). Only 24% of patients below 40 years and 41% of those above 40 years with confirmed rectal carcinoma presented for operation. Conclusion. Advanced tumors at presentation may not always be as a result of late presentation. Unusual aggressiveness of the tumors may lead to rapid progression of the disease. Increasing incidence in younger patients makes abdominoperineal excision of the rectum difficult for such patients to accept.

scholarly journals Analysis of adverse drug reactions of antimicrobial agents reported to ADR monitoring centre of a rural tertiary care teaching hospital

2017 ◽  
Vol 6 (5) ◽  
pp. 1151
Author(s):  
Bhaskar H. Nagaiah ◽  
Shivaraj Basavaraj Patil ◽  
Nallavelly Vahila ◽  
Y. Venkata Rao ◽  
Shrinivas R. Raikar ◽  
...  
Keyword(s):  
Health Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Antimicrobial Agents ◽  
Demographic Data ◽  
Tertiary Care ◽  
Organ System ◽  
Drug Reactions ◽  
Monitoring Centre ◽  
Common System

Background: ADRs are iatrogenic diseases, escalates the burden of health care system by increasing the morbidity and mortality and also additional cost of ADRs management to patients.Methods: A prospective observational study was conducted over 1 year from January 2015 to December 2015. The yellow forms dropped in the red ADR boxes are collected and ADRs due to antimicrobials were analyzed for demographic data, causality, severity, drugs implicated, and organ system affected. The data were presented as counts and percentages.Results: Cephalosporins were the most common antimicrobial class implicated in ADRs, and the dermatological system was the most common system affected by ADRs. All the reactions either belonged to the probable or possible category. Majority of reactions were non-serious.Conclusions: Regular prescription auditing and awareness about polypharmacy will further reduce ADRs due to antimicrobials.

Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Trajchevska ◽  
A. Lleshi ◽  
S. Gjoshev ◽  
A. Trajchevski
Keyword(s):  
Health Care ◽  
Health Status ◽  
Independent Predictor ◽  
Demographic Data ◽  
Parental Satisfaction ◽  
Pediatric Care ◽  
Simple Random Sample ◽  
Significant Independent Predictor ◽  
Cross Sectional ◽  
Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

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