Early Referral for Non-healing Lesions

2021 ◽  
Vol 66 (6) ◽  
pp. 397-399
Keyword(s):  
Early Referral

scholarly journals 368. Clinical Characteristics of Hospitalized COVID-19 American Indian Patients in Rural Arizona

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S253-S254
Author(s):  
Amy Nham ◽  
Ryan M Close
Keyword(s):  
American Indians ◽  
Median Number ◽  
Clinic Visit ◽  
Contact Tracing ◽  
Shortness Of Breath ◽  
Early Referral ◽  
Increased Risk ◽  
Wbc Count ◽  
The Impact ◽  
D Dimer

Abstract Background American Indians have an increased risk of serious complications from COVID-19 due to the high prevalence of comorbidities such as diabetes, heart disease, obesity, and asthma. To date, there has been limited analysis of COVID-19 in the AI population. This study describes the characteristics of hospitalized COVID-19 patients from a well-defined AI population in eastern Arizona. Additionally, we explored the impact of early referral via contact tracing versus those who self-presented. Methods Retrospective chart reviews were completed for patients hospitalized for COVID from March 29 to May 16, 2020. Summary statistics were used to describe demographics, symptoms, pre-existing conditions, and hospitalization data. Results We observed 447 laboratory-confirmed cases of COVID-19, resulting in 71 (15.9%) hospitalizations over a 7-week period and a hospitalization rate of 159 per 1,000 persons. Of the 50 hospitalizations reviewed sequentially, 56% were female, median age of 55 (IQR 44–65). Median number of days hospitalized was 4 (2–6), with 16% requiring intensive care unit support, 15% intubated, 12% readmitted, and 10% deceased. 67% had an epidemiological link, and 32% had an emergency department or outpatient clinic visit within 7 days of hospitalization. All patients were symptomatic; the most common symptoms were cough (90%), shortness of breath (78%), and subjective fever (66%). 86% of patients had a pre-existing condition; the most common pre-existing conditions were diabetes (66%), obesity (58%), and hypertension (52%, Figure 1). All patients had elevated LDH, 94% had elevated CRP, 86% had elevated d-dimer, and 40% had lymphopenia; only 10% had an elevated WBC count and 26% had thrombocytopenia (Table 1). 26% of the patients were referred in by the tracing team (Table 2). Analysis of 500 hospitalizations will be available in October 2020. Conclusion Most AI patients hospitalized had a pre-existing condition, symptoms of cough or shortness of breath, and elevated LDH, CRP, and d-dimer. More research is needed to understand the patterns of COVID-19 related disease in vulnerable populations, like AI/AN, and to examine the utility of early referral by contact tracing teams in rural settings which may guide future tracing strategies. Disclosures All Authors: No reported disclosures

scholarly journals Prevalence of Self-Reported Spondyloarthritis Features in a Cohort of Patients with Inflammatory Bowel Disease

2013 ◽  
Vol 27 (4) ◽  
pp. 199-205 ◽  
Author(s):  
Carmen Stolwijk ◽  
Marieke Pierik ◽  
Robert Landewé ◽  
Ad Masclee ◽  
Astrid van Tubergen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Musculoskeletal Symptoms ◽  
Inflammatory Back Pain ◽  
Early Referral ◽  
History Of ◽  
Seronegative Spondyloarthritis ◽  
Inflammatory Bowel ◽  
Inflammatory Drugs ◽  
Or History

BACKGROUND: Musculoskeletal symptoms belonging to the spectrum of ‘seronegative spondyloarthritis’ (SpA) are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD) and may lead to important disease burden. Patients with suspected SpA should be referred to a rheumatologist for further evaluation.OBJECTIVE: To investigate the self-reported prevalence of musculoskeletal SpA features in a cohort of patients with IBD and to compare this with actual referrals to a rheumatologist.METHODS: Consecutive patients with IBD visiting the outpatient clinic were interviewed by a trained research nurse about possible SpA features using a standardized questionnaire regarding the presence or history of inflammatory back pain, peripheral arthritis, enthesitis, dactylitis, psoriasis, uveitis and response to nonsteroidal anti-inflammatory drugs. All patient files were verified for previous visits to a rheumatologist and any rheumatic diagnosis.RESULTS: At least one musculoskeletal SpA feature was reported by 129 of 350 (36.9%) patients. No significant differences between patients with Crohn disease and ulcerative colitis were found. Review of medical records showed that 66 (51.2%) patients had ever visited a rheumatologist. Axial SpA was diagnosed in 18 (27.3%) patients, peripheral SpA in 20 (30.3%) patients and another rheumatic disorder in 14 (21.2%) patients.CONCLUSION: Musculoskeletal SpA features are frequently present in patients with IBD. However, a substantial group of patients is not evaluated by a rheumatologist. Gastroenterologists play a key role in early referral of this often debilitating disease.

Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology follow-up matter?

2016 ◽  
Vol 18 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Naveed Ul Haq ◽  
Mohamed Said Abdelsalam ◽  
Mohammed Mahdi Althaf ◽  
Abdulrahman Ali Khormi ◽  
Hassan Al Harbi ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinic Visit ◽  
Study Data ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Early Referral ◽  
Period Data ◽  
Stage Renal Disease ◽  
End Stage

Background Native arteriovenous fistulae (AVFs) are preferred while central venous catheters (CVCs) are least suitable vascular access (VA) in patients requiring hemodialysis (HD). Unfortunately, around 80% of patients start HD with CVCs. Late referral to nephrologist is thought to be a factor responsible for this. We retrospectively analyzed the types of VA at HD initiation in renal transplant recipients followed by nephrologists with failed transplant. If early referral to nephrologist improves AVF use, these patients should have higher prevalence of AVF at HD initiation. Methods All patients who failed their kidney transplants from January 2002 to April 2013 were included in the study. Data regarding planning of VA by nephrologist, documented discussion about renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR) at 6 months and last clinic visit before HD initiation, time of VA referral, and subsequent VA at dialysis initiation were gathered and analyzed. Results Eighty-three patients failed their transplants during study period. Data were inaccessible in six patients. Eleven patients started peritoneal dialysis (PD) while 66 started HD. Thirty-two had previous functioning VA while 34 needed VA. There were 11/34 patients (32%) with eGFR <15 mL/min at six months while 21/34 (61%) had eGFR <15 mL/min at last clinic visit before HD initiation. Only 11/34 (32%) had documented RRT discussion, 8/34 (24%) had VA referral, and 7/34 (21%) had vein mapping. A total of 30/34 (88.3%) started HD with CVC while 4/34 (11.3%) started HD with AVF (p<0.0001). Conclusions Early referral to nephrologist by itself may not improve VA care amongst patient with end-stage renal disease.

scholarly journals Role of Paediatricians in Paediatric Ophthalmology

2013 ◽  
Vol 33 (1) ◽  
pp. 80-82
Author(s):  
Ujjowala Devi Shrestha
Keyword(s):  
Vitamin A Deficiency ◽  
Early Screening ◽  
Early Referral ◽  
Eye Health ◽  
Total Lack ◽  
Eye Examination ◽  
The Common ◽  
One Year ◽  
Paediatric Ophthalmology

Children are primarily examined by paediatricians. In Nepal, child health is in low priority due to illiteracy, there is total lack of awareness about children’s eye health. The common avoidable causes of childhood blindness are refractive errors, amblyopia, retinopathy of prematurity (ROP), vitamin A deficiency (VAD), xerophthalmia, ophthalmia neonatorum (ON), congenital cataract, and retinoblastoma. Paediatricians could be the key persons for early referral of these children to a paediatric ophthalmologist. Paediatricians can send the patients for eye examination after birth within 6 weeks, at 6 months, at one year and before going to school. In conclusion, early screening and referral by the paediatricians to the paediatric ophthalmologist prevents children from being sightless. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7605 J Nepal Paediatr Soc. 2013;33(1):80-82

scholarly journals Disorders of gender identity: what to do and who should do it?

2014 ◽  
Vol 204 (2) ◽  
pp. 96-97 ◽  
Author(s):  
James Barrett
Keyword(s):  
Primary Care ◽  
Gender Identity ◽  
Gender Role ◽  
Treatment Plan ◽  
Hormone Treatment ◽  
Sex Hormone ◽  
Early Referral ◽  
Sustained Improvement ◽  
Social State ◽  
Gender Reassignment

SummaryTranssexualism is not usually indicative of psychopathology. In carefully selected individuals, with multidisciplinary support, a change of social gender role and cross-sex hormone treatment greatly improves the psychological and social state. Sustained improvement merits gender reassignment surgery. The key is early referral with subsequent primary care cooperation in the treatment plan.

scholarly journals Development of Red Flags Index for Early Referral of Adults with Symptoms and Signs Suggestive of Crohn’s Disease: An IOIBD Initiative

2015 ◽  
Vol 9 (8) ◽  
pp. 601-606 ◽  
Author(s):  
Silvio Danese ◽  
Gionata Fiorino ◽  
Jean-Yves Mary ◽  
Peter L. Lakatos ◽  
Geert D’Haens ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Red Flags ◽  
Early Referral ◽  
Symptoms And Signs

scholarly journals Behavioural Problems and Parental Over-protectiveness in Children with Asthma

2017 ◽  
Vol 36 (3) ◽  
pp. 232-237
Author(s):  
Neena Sanjiv Sawant ◽  
Juhi Bhargava ◽  
Chandrahas T. Deshmukh
Keyword(s):  
Demographic Variables ◽  
Behavioural Problems ◽  
Control Group ◽  
Behaviour Problem ◽  
Early Referral ◽  
Parental Awareness ◽  
Children With Asthma ◽  
Minor Ailments ◽  
And Control ◽  
Asthma Group

Introduction: Asthma in children often leads to behavioural problems due to the chronic nature of the disease. Parents also tend to be overprotective and many may not even consult a doctor for the same. The objectives were to study the various behavioural problems seen in children having asthma as compared to those with minor ailments, parental awareness about the same and their parenting styles.Material and Methods: 75 parents of children of bronchial asthma and 75 parents of children having short term minor ailments formed the asthma and control groups respectively. The Behaviour Problem Index was used to assess the behavioural problems in children as documented by parents and parental overprotectivenesswas assessed using the Vulnerable Child/ Overprotecting Parent Scale.Results:The demographic variables were comparable in both the groups. Behavioural problems on all domains and parental over protectiveness in the asthma group were found to be statistically significant as compared to control group. However there was no significant correlation between the parental over-protectivenessand the behavioural problems in both the groups.Conclusions: Early referral to the psychiatrist with parental counselling will result in better outcomes for the child.J Nepal Paediatr Soc 2016;36(3):232-237

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