scholarly journals The Care Pathway Delays of Cervical Cancer Patient in Morocco

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Hind Mimouni ◽  
Khalid Hassouni ◽  
Boujemaa El Marnissi ◽  
Bouchra Haddou Rahou ◽  
Leila Alaoui ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Health System ◽  
Cancer Care ◽  
Care Pathway ◽  
Diagnostic Delay ◽  
Patient Delay ◽  
University Hospital ◽  
Cervical Cancer Patient ◽  
Diagnosis Delay ◽  
Time Intervals

Introduction. The aim of this study is to document time intervals in cervical cancer care pathways, from symptom onset to disease detection and start of treatment, and evaluate how clinical, sociodemographic, and treatment factors influence delays throughout a patient’s clinical pathway. Methods. A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in Morocco. Results. 190 medical records of cervical cancer patients were collected. The dominant age group was 35–44, the median patient delay (PD) was 6 days, the median healthcare provider’s delay (HCP) was 21 days, the median referral delay (RD) was 17 days, the median diagnostic delay (DD) was 9.5 days, the median total diagnostic delay (TDD) was 16 days, the median treatment delay (TD) was 67 days, and the median health system interval (HSI) was 92 days. Multivariate analysis revealed that age was associated with the patient delay, the healthcare provider’s delay, the diagnosis delay, and the health system interval. The diagnosis year (the year in which the patient was diagnosed (either before 2012 or during 2012 as well as the other study years (from 2013 to 2017))), all investigations done prior to admission to the oncology hospital, and the age of first sexual activity were significantly associated with healthcare provider’s delay. Conclusion. The integration of a model and standard care pathway into the Moroccan health system is essential in order to unify cervical cancer care in the country.

scholarly journals Comparison of Delay in Tuberculosis Diagnosis Between Migrants and Local Residents in an Eastern County of China: An Analysis of the Electronic Data Between 2015 and 2019

2021 ◽  
Vol 9 ◽  
Author(s):  
Wenhui Xiao ◽  
Bin Chen ◽  
Dajiang Huang ◽  
Olivia Chan ◽  
Xiaolin Wei ◽  
...  
Keyword(s):  
Health System ◽  
Diagnostic Delay ◽  
Information Management System ◽  
Evidence Base ◽  
Patient Delay ◽  
Rank Test ◽  
Time Interval ◽  
System Delay ◽  
Early Screening ◽  
Health System Delay

Introduction: China continues to rank among one of the countries with the highest number of tuberculosis (TB) cases globally. Migrants are a particularly at-risk subgroup for TB and pose a challenge for case management in contemporary China. The early diagnosis and treatment of patients with TB are pivotal for effective TB control. This study investigates the delay in the TB diagnosis of migrants as compared with residents, to provide an evidence base for improved case detection and the better management of migrant patients with TB.Materials and Methods: The data was collected from the Tuberculosis Information Management System (TBIMS) (2015–2019) in an eastern county of China. The total diagnostic delay, consisting of patient delay and health system delay, is defined as the interval between the onset of TB symptoms and the confirmation of TB diagnosis in the designated TB hospital. The comparison of the delay in the TB diagnosis between migrants and residents was conducted using a Mann-Whitney U-test and chi-square test. The difference in the delay curves between these two groups was examined using a log-rank test.Results: Of 2,487 patients with TB, 539 (22%) were migrants. The migrants tended to be younger, presented with less severe conditions, received an initial diagnosis at prefectural and above-level hospitals. Compared with the local patients with TB, the migrant patients with TB had a longer median total diagnostic delay (30 vs. 9, P = 0.000) and a higher proportion of patients with this delay >28 days (52 vs. 13%, P = 0.000). Similarly, the migrant patients with TB also had a longer median patient delay (13 vs. 9, P = 0.000) and a higher proportion of patients with this delay >14 days (47 vs. 30%, P = 0.000), longer median health system delay (9 vs. 0, P = 0.000), and a higher proportion of patients with this delay >14 days (42 vs. 0.5%, P = 0.000) than the local patients with TB. The survival curves of delay showed that the longer the time interval was, the more likely the migrant patients with TB were to be diagnosed (P < 0.05).Conclusions: Diagnosis is significantly delayed among migrant patients with TB. Our study highlights the importance of early screening and diagnosis for TB especially among migrants, to improve access and ensure better management for all patients with TB.

scholarly journals Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260870
Author(s):  
Thea C. Heil ◽  
René J. F. Melis ◽  
Huub A. A. M. Maas ◽  
Barbara C. van Munster ◽  
Marcel G. M. Olde Rikkert ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Technical Efficiency ◽  
Cancer Care ◽  
Older Patients ◽  
Care Pathway ◽  
Practice Variation ◽  
Preoperative Care ◽  
Postoperative Outcomes ◽  
University Hospital ◽  
Truncated Regression

Background Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. Methods Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians’ judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores. Results Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001). Conclusion This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.

scholarly journals Facteurs De Retard Diagnostique De La Tuberculose Pulmonaire Vus À l’Unité De Soins, De Formation Et De Recherche De Pneumologie Befelatanana

2017 ◽  
Vol 13 (27) ◽  
pp. 413
Author(s):  
Ravahatra Kiady ◽  
Michel Tiaray Harison ◽  
Rakotondrabe Iantsotiana Davidson ◽  
Rasoafaranirina Marie Odette ◽  
Nandimbiniaina Anjara ◽  
...  
Keyword(s):  
Health System ◽  
Patient Delay ◽  
Diagnosis Delay ◽  
System Delay ◽  
Total Delay ◽  
Delay In Diagnosis ◽  
Health System Delay ◽  
Tuberculosis Diagnosis ◽  
Tuberculose Pulmonaire ◽  
A Prospective Study

Delay in diagnosis is significant to tuberculosis prognosis. The aim of this study is to evaluate the diagnosis delay of tuberculosis and to identify determinants of “patient delay”, “health system delay”, and “total delay” in the diagnosis of tuberculosis. It is a prospective study of the patients who were hospitalized at the Unité de Soins de Formation et de Recherche (USFR) of Pneumology in Befelatanana, Antananarivo Madagascar, during the period of 1 st October 2014 to 30 April 2015 (7 months). We included all patients with diagnosis of pulmonary tuberculosis. Sixty six patients were also included. The mean time of patient delay, health system delay, and total delay were 26,30± 36,87, 69,56±64, and 96,35±72,65 days respectively. The different variables that affected diagnosis delay were: tobacco smoke (OR : 3,6723), asthenia (OR : 5,4815), anorexia (OR : 2,9524), and hemoptysis (OR : 0,2406) for the total delay. Knowledge about tuberculosis signs (OR : 0,164) and transmissions (OR : 0,243) was for the patient delay. Hemoptysis (OR : 8,1250), asthenia (OR : 0,1081), breathlessness (OR : 0,3556), infiltrative syndrome (OR : 0,2500), and alveolar syndrome (OR : 0,0687) in chest Xray was for the health system delay. Having an understanding of these factors of tuberculosis diagnosis delay will result to a decrease in the diagnosis delay.

scholarly journals Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancer: A Pilot Model

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 39s-39s
Author(s):  
Armando Sardi ◽  
Mavalynne Orozco-Urdaneta ◽  
Carolina Velez-Mejia ◽  
Andres Perez ◽  
Carlos Munoz-Zuluaga ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Diagnosis ◽  
Health System ◽  
Cancer Care ◽  
Tertiary Care ◽  
Control Plan ◽  
Cervical Cancers ◽  
Breast And Cervical Cancer ◽  
Pilot Model ◽  
Level 1

Purpose Breast and cervical cancers are leading causes of mortality in Latin America. Although Colombia has an integrated health system that provides universal coverage, approximately 70% of patients with cancer are diagnosed in a late stage. The government has a 10-year cancer control plan that is focused on prevention, early detection, and treatment; however, many barriers have hindered its implementation. Since 2012, Partners for Cancer Care and Prevention has worked to decrease the burden of breast and cervical cancer by mitigating the obstacles women face during their cancer journeys. Methods Through community outreach and meetings with medical personnel, hospital directors, and government officers, we identified some of the barriers—a deficit of trained personnel and physicians, limited centers and scarcity of equipment for early diagnosis, and a fragmented health system with poor continuity of care. Our proposal included monthly teleconferences, a twice-a-year on-site training and quality control program, improving the equipment for early diagnosis in easily accessible centers for patients, creating a patient navigation program and a mobile application (Amate), and unifying the system by directing patients for diagnosis to level 1 and 2 hospitals with rapid referral for treatment in level 3. Results From 2012 to 2016, we have trained 462 health professionals in the screening, diagnosis, and treatment of breast and cervical cancers and equipped level 1 and 2 hospitals for cancer diagnosis by donating a mammography machine and two video colposcopes, all of which has yielded 3,036 mammograms and 1,500 uterocervical cytologies annually. In addition, Amate is able to provide basic teaching and rapid referral for screening. Thus far, 2,583 women have benefited from the program. This has integrated the health system and shortened wait times. After 4 years, the time from initial consult to biopsy has decreased from 65 days to 20 days (70%), from biopsy to surgery for 154 days to 64 days, and from biopsy to chemotherapy from 148 days to 72 days. Conclusion A system of early diagnosis in level 1 and 2 hospitals—now centers of excellence—with rapid referral to a tertiary care institution has facilitated the implementation of the cancer program in Colombia. Although several barriers are still to be addressed, we are establishing an efficient health care model that could be replicated in other underserved countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Armando Sardi Stock or Other Ownership: Celgene, Johnson & Johnson Mavalynne Orozco-Urdaneta Employment: Partners For Cancer Care And Prevention Foundation, Stamina-in-Action Stock or Other Ownership: Celgene, Johnson & Johnson Luis Gabriel Parra-Lara Research Funding: Merk & Co

scholarly journals COVID-19 does not stop obstetrics: what we need to change to go on safely birthing. The experience of a University Obstetrics and Gynecology Department in Milan

2020 ◽  
Vol 48 (9) ◽  
pp. 997-1000
Author(s):  
Nikita Alfieri ◽  
Stefano Manodoro ◽  
Anna Maria Marconi
Keyword(s):  
Health System ◽  
University Hospital ◽  
Obstetrics And Gynecology ◽  
Daily Routine ◽  
Clinical Services ◽  
Wuhan City ◽  
Set Up

AbstractSince SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.

scholarly journals AB0664 DIAGNOSIS DELAY IN ANKYLOSING SPONDYLITIS PATIENTS IN EGYPT: FACTORS, SOCIOECONOMIC AND CLINICAL OUTCOME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1627.2-1627
Author(s):  
F. I. Abdelrahman ◽  
M. Mortada
Keyword(s):  
Ankylosing Spondylitis ◽  
Social Life ◽  
Activity Index ◽  
Diagnostic Delay ◽  
Disease Activity Index ◽  
Diagnosis Delay ◽  
Functional Index ◽  
Delay In Diagnosis ◽  
Significant Difference ◽  
The Mean

Background:Ankylosing spondylitis (AS) is a destructive inflammatory disease which was reported to have the longest diagnostic delay among the inflammatory rheumatic disease. This lag period have a great impact on the clinical outcome and socioeconomic state of the patients. With the advent of tumor necrosis factor-α (TNF-α) inhibitors, early diagnosis in AS has become important(1).Objectives:to evaluate the period from symptom onset to diagnosis of AS in Egyptian patients and to examine possible reasons for delayed diagnosis and its impact on the economic and social life of the patients.Methods:The study included 87 AS patients diagnosed according to the Assessment of Spondyloarthritis international Society (ASAS) criteria (2). A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first AS symptom and correct diagnosis of AS. Clinical and functional assessment of axial SpA measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI). The direct medical cost during years of delay (including costs of medical consultations, medications, investigations, physiotherapy and surgical treatment) had been estimated by Egyptian pound.Results:The study included 87 AS patients with mean age (30.03±8.3), 70 male (80.5%) and 17 female (19.5%).Mean delay in diagnosis was(5.7 ±4.9) years. Mean of diagnostic delay for patient diagnosed before 2010 is (14±4.4) and that of patients diagnosed after 2010 is (3.5±1.8) with significant difference between both (p value<0.0001). The main cause of delay was incorrect diagnosis as follow degenerative disc disease (43/87, 49.4%), non-specific back pain (31/87, 35.6%), rheumatoid arthritis (10/87,11.5%), rheumatic fever (2/87, 2.3%) and tuberculosis of spine (1/87, 1.1%). The mean of the medical visits was (6±5.4). Most incorrect initial diagnoses were made by orthopedicians (57.9%), followed by neurologists (22.2%) followed by rheumatologist (10%) and general phyisicians (9.9%). Absence of extra-articular manifestations, negative family history and juvenile age are significantly associated with diagnostic delay. Delay in diagnosis is significantly associated with higher disease activity index(BASDAI), functional index (BASFI), and damage index(BASMI). The mean of the costs during years of delay is (15671.3±546.1) with the mean of cost per each year delay (660.9±6.6) with high significant association between the cost and longer delay in diagnosis (<0.0001). Regarding work ability, we found that(32.2%) are fit for work, unfit (29.9%), partially fit (37.9%) with high significant difference between ability of work and shorter delay. Regarding social effect, 40.2 % of patients developed negative effect on social life with significant association to diagnostic delay (0.004).Conclusion:Our study confirmed the importance of early diagnosis of AS due to its impact on patient’s health outcome and socioeconomic state.We recommend to increase the awareness about the disease among healthcare professionals in our region.References:[1]Sykes M. et al: Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis; Ann Rheum Dis.2015;74:e44.[2]Rudwaleit M. et al: The development of Assessment of Spondyloarthritis international Society classification criteria for axial spondyloarthritis; Ann Rheum Dis, 68 (2009), pp.777-783.Disclosure of Interests:None declared

scholarly journals Typical Time to Treatment of Patients With Lung Cancer in a Multisite, US-Based Study

2016 ◽  
Vol 12 (6) ◽  
pp. e643-e653 ◽  
Author(s):  
Regina M. Vidaver ◽  
Marianna B. Shershneva ◽  
Scott J. Hetzel ◽  
Timothy R. Holden ◽  
Toby C. Campbell
Keyword(s):  
Lung Cancer ◽  
Cancer Care ◽  
Disease Incidence ◽  
The United States ◽  
Small Cell ◽  
Time Intervals ◽  
Time To Treatment ◽  
Specialist Referral ◽  
Patient Reported ◽  
Typical Time

Introduction: The importance of high-quality, timely lung cancer care and the need to have indicators to measure timeliness are increasingly discussed in the United States. This study explored when and why delays occur in lung cancer care and compared timeliness between two states with divergent disease incidence. Methods: Patients with small-cell or non–small-cell lung cancer were recruited through cancer centers, outpatient clinics, and community approaches, and interviewed over the phone. Statistical analysis of patient-reported dates included descriptive statistics and comparing time intervals between states and across the sites with Mann-Whitney U tests. Additionally, data from patients with longer timelines were qualitatively analyzed to identify possible reasons for delays. Results: On the basis of the dates reported by 275 patients, the median time from first presentation to a clinician to treatment was 52 days; 29% of patients experienced a wait of 90 days or more. Median times for key intervals were 36.5 days from abnormal radiograph to treatment, 9.5 days from initial presentation to specialist referral, 15 days from patient informed of diagnosis to first therapy, and 16 days from referral to treatment to first therapy. More than one quarter of patients perceived delays in care. No significant differences in length of time intervals were identified between states. Monitoring of small nodules, missed diagnosis, and other reasons for longer timelines were documented. Conclusion: Results defined typical time to treatment of patients with lung cancer across a variety of health systems and should facilitate establishing metrics for determining timeliness of lung cancer care.

Morbidity and mortality of pelvic exenteration for cervical cancer at a German referral center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17505-e17505
Author(s):  
Jelena Boekhoff ◽  
Luisa terGlane ◽  
Uwe Wagner ◽  
Axel Hegele
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Pelvic Exenteration ◽  
Survival Rates ◽  
Operation Time ◽  
Previous Treatment ◽  
University Hospital ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Recurrent Cervical Cancer

e17505 Background: The purpose of this study was to evaluate data regarding the outcome of pelvic exenteration (PE) when performed for advanced or recurring cervical cancer. Methods: A total of 24 patients underwent PE for cervical cancer at the University Hospital Marburg between 2011 and 2016. Their data were retrospectively assessed and statistically analyzed. Survival was evaluated using the Kaplan-Meyer method. Results: Mean age was 52.2 years (29.7 to 72.6 years), mean BMI was 23.4 kg/m2. Most common indication was squamous cell carcinoma, whereas 3 patients underwent PE for adenocarcinoma. The majority of the tumors (62.5%) were stage pT4. Negative margins could be achieved in 70.8%. Lymph nodes could be assessed in 55% and were tumor-afflicted in 20.8%. 45.8% were treated for recurrent cancer; median recurrence free time between previous treatment and PE was 16 months. Up-front PE was performed in 20.8%. Another 79.2% received treatment prior to PE: 20.8% received all 3 treatment modalities whereas 37.5% had two treatments before (29.2% underwent chemo- and radiotherapy, 8.3% had surgery and radiotherapy) and 20.8% underwent one type of treatment. Anterior PE (APE) and total PE (TPE) were performed in 62.5% and 37.5%, respectively. Median operation time was 324min. Blood products were administered perioperatively in 75%; 37.5% needed 2 or more. Median hospital stay was 25 days. Major complications (Clavien Dindo≥3) were observed in 41.7% and 16.7% had no complications. Overall Survival (OS) was 29.2%; median overall survival was 19.1 months. 2- and 3-year survival rates for curative PE were 50% and 35% respectively. 4 patients underwent PE with palliative intent. Overall survival correlated significantly with R1- (p = 0.012), N1- (p = 0.047) and M1-status p < 0.01), TPE (p = 0.034) and surgical time > 6 h (p = 0.003). Conclusions: In cases of advanced or recurrent cervical cancer gynecologists struggle to find suitable therapeutic options, especially since most patients have already received radio- and/or chemotherapy. PE is a valid option for selected patients that may represent a cure with tolerable complication rates.

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