Diagnostic flow for all patients referred with non-specific symptoms of cancer to a diagnostic centre in Denmark: A descriptive study.

BACKGROUND: Since 2012, Cancer Patient Pathways for Non-specific Symptoms and Signs of Cancer (NSSC-CPP) have been implemented in Scandinavia and UK. OBJECTIVES: This study aimed to describe the diagnostic flow for all patients referred from 1 January to 30 June 2020 to the NSSC-CPP in the Diagnostic Centre in Farsø (DC-F), Denmark. METHODS: During the study period, we prospectively recorded information on the diagnostic flow, including: pathway trajectory, symptoms and findings leading to referral, diagnostic procedures and diagnoses at the end of DC Farsø work-up and within 6-months for all patients referred to the NSSC-CPP in DC Farsø using electronic patient files and the Danish National Patient Registry (DNPR). RESULTS: Of the 314 referrals to DC Farsø, 227 had diagnostic work-up in DC Farsø, the remaining were redirected to other CPPs (n = 11), outpatient clinics (n = 45) or redirected to general practice (n = 25). Of total referrals, 25 (8%) received a malignant diagnosis, 20 (6%) a non-malignant but clinically relevant diagnosis with initiation of treatment, 16 (5%) a non-malignant diagnosis but no treatment needed and in 253 (81%) referrals no severe new condition was diagnosed. Two (1%) additional malignancies were diagnosed within a 6-month follow-up period. CONCLUSION: By tracking all patients referred to the NSSC-CPP in DC Farsø, including those redirected, this is the first study to describe the diagnostic flow for all patients referred to a diagnostic centre in Denmark. This knowledge is important for further organisation and planning of the NSSC-CPP.

Eight percent of NSSC-CPP referrals yielded cancer diagnoses, with two additional cancers diagnosed in a 6-month follow-up.Over one-fourth of referrals to NSSC-CPP were redirected to other departments or general practitioners.This study outlines the diagnostic flow for all NSSC-CPP-referred patients, offering unique insights crucial for comparing European diagnostic practices.

Non-specific symptoms-based pathways for diagnosing less common cancers in primary care: a service evaluation.

BACKGROUND: Although less common cancers account for almost half of all cancer diagnoses in England, their relative scarcity and complex presentation, often with non-specific symptoms, means that patients often experience multiple primary care consultations, long times to diagnosis, and poor clinical outcomes. An urgent referral pathway for non-specific symptoms, the Multidisciplinary Diagnostic Centre (MDC), may address this problem. AIM: To examine the less common cancers identified during the MDC pilots and consider whether such an approach improves the diagnosis of these cancers. DESIGN AND SETTING: A service evaluation of five MDC pilot projects in England from December 2016 to March 2019. METHOD: Data items were collected by pilot sites in near-real time, based mainly on the English cancer outcomes and services dataset, with additional project-specific items. Simple descriptive and comparative statistics were used, including χ2 tests for proportions and t-tests for means where appropriate. RESULTS: From 5134 referrals, 378 cancers were diagnosed, of which 218 (58%) were less common. More than 30 different less common tumour types were diagnosed in this cohort. Of the MDC patients with less common cancers, 23% (n = 50) had ≥3 GP consultations before referral and, at programme level, a median time of 57 days was recorded from GP urgent referral to treatment for these tumour types. CONCLUSION: A non-specific symptomatic referral route diagnoses a broad range of less common cancers, and can support primary care case management for patients with symptoms of possible cancer that do not qualify for a site-specific urgent referral.

Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices.

Point-of-care testing (POCT)-laboratory tests performed with new mobile devices and online technologies outside of the central laboratory-is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP's network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

An audit of request forms submitted in a multidisciplinary diagnostic center in Lagos.

INTRODUCTION: Request forms are important means of communication between physicians and diagnostic service providers. Pre-analytical errors account for over two thirds of errors encountered in diagnostic service provision. The importance of adequate completion of request forms is usually underestimated by physicians which may result in medical errors or delay in instituting appropriate treatment. The aim of this study was to audit the level of completion of request forms presented at a multidisciplinary diagnostic center. METHODS: A review of all requests forms for investigations which included radiologic, laboratory and cardiac investigations received between July and December 2011 was performed to assess their level of completeness. The data was entered into a spreadsheet and analyzed. RESULTS: Only 1.3% of the 7,841 request forms reviewed were fully completed. Patient's names, the referring physician's name and gender were the most completed information on the forms evaluated with 99.0%, 99.0% and 90.3% completion respectively. Patient's age was provided in 68.0%, request date in 88.2%, and clinical notes/ diagnosis in 65.9% of the requests. Patient's full address was provided in only 5.6% of requests evaluated. CONCLUSION: This study shows that investigation request forms are inadequately filled by physicians in our environment. Continuous medical education of physicians on the need for adequate completion of request forms is needed.

Treatment referral system for tuberculosis patients in Dhaka, Bangladesh.

OBJECTIVE: To evaluate the referral system in an urban DOTS-based programme in Dhaka, Bangladesh, including the peri-urban area, and to identify opportunities to strengthen the system. DESIGN: This was a retrospective cohort study in which diagnosed tuberculosis (TB) patients and health providers from DOTS centres were interviewed. Research tools included pre-tested structured questionnaires and the TB patients' referral records. RESULTS: Of 4974 TB patients who were referred to the different treatment centres, only 1756 (35%) of the counterfoils of the referral slips were returned. Of 250 patients randomly selected for interview, 165 reported to a DOTS centre, 69 did not and 16 could not be traced. Variations in educational qualification, residence and the identification of DOTS centres after counselling were statistically significant (P < 0.05). Lower monthly income (RR = 7.84, RR = 5.03), distance from the centre (RR = 36.21) and those receiving treatment from pharmacies (RR = 3) or non-governmental organisations (RR = 28.48) have more risk of irregular treatment. CONCLUSION: A high proportion of referred patients were registered and initiated treatment, but many did not report to the referral treatment centre. Proper counselling and taking into account the patients' preferences during referral are essential to address access barriers to treatment adherence and improved treatment outcome.

Objectif : Evaluer le système de référence dans les programmes de DOTS urbains dans la ville de Dhaka, Bangladesh, et sa banlieue et à identifier les opportunités de renforcer ce système.Schéma : Une étude rétrospective de cohorte a interviewé les patients ayant eu un diagnostic de TB et les prestataires de soins des centres de diagnostic et de traitement (DOTS). Les outils de recherche ont inclus des questionnaires structurés pré testés et de registres de référence de patients TB.Résultats : Un total de 4974 patients TB a été référé aux différents centres de traitement. Seulement 1756 (35%) des fiches de référence des homologues ont été retournées. Parmi eux, 250 patients ont été sélectionnés au hasard pour un entretien. Parmi eux, 165 patients sont allés dans les centres DOTS, 69 n'y sont pas allés et 16 n'ont pas pu être retrouvés. On a découvert des variations statistiquement significatives en matière de niveau d'instruction, de lieu de résidence et d'identification du centre DOTS après conseil (P < 0,05). Les personnes ayant un revenu mensuel plus faible (RR = 7,84 ; RR = 5,03), la distance par rapport au centre (RR = 36,21) et prenant leur traitement dans une pharmacie et divers autres lieux ont eu un risque plus élevé (RR = 3 ; RR = 28,48) de prendre un traitement irrégulier.Conclusion : Un bon nombre de patients référés ont été enregistrés et ont mis en route le traitement mais ne sont pas retournés au centre de traitement indiqué. Un conseil adapté et le fait de tenir compte des préférences du patient pendant la référence sont essentiels pour répondre aux contraintes d'accès, pour l'adhésion au traitement et pour un meilleur résultat du traitement.

Objetivo: Evaluar el sistema de remisiones en el marco de la estrategia DOTS y reconocer las oportunidades que existen de fortalecer el sistema y se llevó a cabo en la ciudad de Dhaka, Bangladesh, incluida su zona periurbana.Método: Fue este un estudio retrospectivo de cohortes, en el cual se administraron entrevistas a los pacientes con diagnóstico de tuberculosis (TB) y a los trabajadores de salud de los centros DOTS de diagnóstico y tratamiento. Los instrumentos de la investigación consistieron en cuestionarios estructurados y registros de las remisiones de los pacientes con TB.Resultados: Se remitieron 4974 pacientes con diagnóstico de TB a los diferentes centros de tratamiento. Solo se recibieron 1756 notificaciones de contrarreferencia en los centros de origen (35%). De estos pacientes se escogieron de manera aleatoria 250 para las entrevistas. De los pacientes escogidos, 165 se habían registrado en el centro DOTS, 69 no se presentaron y fue imposible localizar a 16 de los pacientes. Los factores significativos que determinaron estas diferencias fueron el grado de instrucción, el lugar de residencia y la capacidad de seguir las instrucciones para localizar el centro DOTS (P < 0,05). Se observó que el riesgo de irregularidad en cumplimiento terapéutico se asoció con un ingreso mensual más bajo (hasta 10 000 takas, riesgo relativo [RR] = 7,84; de 10 000 takas a 20 000 takas, RR = 5,03), el hecho de vivir a una distancia mayor del centro DOTS (RR = 36,21) y de haber recibido el tratamiento en una farmacia (RR = 3) o en centros diferentes a los designados (RR = 28,48).Conclusión: Un buen número de pacientes remitidos se registró e inició el tratamiento antituberculoso, pero muchos no acudieron al centro específico DOTS. Es primordial ofrecer una orientación adecuada y tener en cuenta las preferencias del paciente durante la remisión, a fin de superar los obstáculos que existen al cumplimiento del tratamiento y obtener mejores resultados terapéuticos.

Guidelines for ultrasound owners and owners of clinics, diagnostic centres, nursing homes and hospitals.

These are guidelines that are required for ultrasound owners for registration and use of ultrasound machines and are applicable across India. A brief description of the violations and penalties has also been listed.