Compliance with McDonald criteria and red flag recognition in a general neurology practice in Ireland

2010 ◽  
Vol 16 (6) ◽  
pp. 678-684 ◽  
Author(s):  
Christine Albertyn ◽  
Sean O'Dowd ◽  
John McHugh ◽  
Raymond Murphy
Keyword(s):  
Consensus Statement ◽  
Clinical Presentation ◽  
Red Flags ◽  
Clinical Notes ◽  
Important Principle ◽  
Mcdonald Criteria ◽  
Red Flag ◽  
Lost To Follow Up ◽  
Over Time

Background: The revised McDonald criteria aim to simplify and speed the diagnosis of multiple sclerosis (MS). An important principle of the criteria holds there should be no better explanation for the clinical presentation. In Miller et al.’s consensus statement on the differential diagnosis of MS, red flags are identified that may suggest a non-MS diagnosis. Objective: All new patients with a practice diagnosis of MS were assessed for compliance with McDonald criteria. The group of patients not fulfilling criteria was followed up to assess compliance over time. At the end of the follow-up period, red flags were sought in the group of patients who remained McDonald criteria negative. Methods: Clinical notes and paraclinical tests were examined retrospectively for compliance with McDonald criteria and for the presence of red flags. Results: Sixty-two patients were identified, with two lost to follow-up. Twenty-six (42%) patients fulfilled criteria at diagnosis. After 53 months follow-up, 47 (78%) patients fulfilled criteria. In the 13 (22%) patients who remain McDonald criteria negative, a total of 20 red flags were identified, ranging from one to six per patient. Alternative diagnoses were considered and further investigations performed in 10 patients with no significantly abnormal results. Conclusion: Twenty-two percent of patients still do not fulfill McDonald criteria after 53 months. Dissemination in time was not proven in the majority of patients and the lack of follow-up neuroimaging was an important factor in this. Red flags may be useful in identifying alternative diagnoses, but the yield was low in our cohort.

scholarly journals Prognosis and treatment of 46 Chinese pediatric cystic fibrosis patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qionghua Chen ◽  
Yuelin Shen ◽  
Hui Xu ◽  
Xiaolei Tang ◽  
Haiming Yang ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Respiratory Tract Infections ◽  
Adverse Reactions ◽  
Clinical Presentation ◽  
Public Awareness ◽  
Sputum Production ◽  
Tract Infections ◽  
Lost To Follow Up

Abstract Background Since public awareness of cystic fibrosis (CF) has increased, more children have been diagnosed with CF in China. This study aimed to investigate medical and other challenges faced by pediatric CF patients in China. Method Treatments and treatment outcomes were retrospectively analyzed for 46 pediatric CF patients diagnosed from August 2009 to June 2019. Pre- and post-treatment results were compared using independent samples t-test. Results Of 46 pediatric CF study patients, four died and five were lost to follow-up. Thirty-seven patients were monitored for 0.03 to 9.21 years; patients exhibited fewer attacks of respiratory tract infections after diagnosis (4.49 ± 2.13 episodes/year before diagnosis vs 1.97 ± 1.87 times/year after 1-year treatment, p < 0.05), significantly reduced sputum production and experienced 1.62 ± 1.71 exacerbations/year. Patient mean body mass index was 16.87 ± 3.53 and pancreatic malfunction persisted in 15 patients. For 17 children, no significant differences in lung function were found at follow-up as compared to lung function at diagnosis (FEV1: 82.45% ± 16.56% vs 75.26% ± 22.34%, FVC: 87.18% ± 13.64% vs 86.99% ± 19.95%, FEF75%: 46.51% ± 28.78% vs 36.63% ± 24.30%, P = 0.27, 0.97, 0.20, respectively). Pseudomonas aeruginosa (17/27) and bronchiectasis (22/22) were found during follow-up evaluation. Twenty-four patients (64.8%) maintained good adherence to therapies. Overall, azithromycin and tobramycin treatments were administered for 0.5–62 months and 0.5–48 months, respectively, and triggered no obvious adverse reactions. Conclusion No obvious declines in clinical presentation or lung function were found in Chinese pediatric CF patients after receiving standard therapeutic and active treatments, although malnutrition and low compliance were persistent challenges.

Natural course of untreated cluster headache: A retrospective cohort study

Cephalalgia ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 655-661 ◽  
Author(s):  
Mi Ji Lee ◽  
Hyun Ah Choi ◽  
Jong Hwa Shin ◽  
Hea Ree Park ◽  
Chin-Sang Chung
Keyword(s):  
Cluster Headache ◽  
Disease Duration ◽  
Medical Center ◽  
Natural Course ◽  
Duration Of Disease ◽  
Lost To Follow Up ◽  
Active Patients ◽  
Single Predictor ◽  
Over Time

Objective To determine the natural course of cluster headache. Methods We screened patients with cluster headache who were diagnosed at Samsung Medical Center and lost to follow-up for ≥5 years. Eligible patients were interviewed by phone about the longitudinal changes in headache characteristics and disease course. Remission was defined as symptom-free 1) for longer than twice the longest between-bout period and 2) for ≥5 years. Results Forty-two patients lost to follow-up for mean 7.5 (range, 5.0–15.7) years were included. The length of the last bout did not differ from the first one, while the last between-bout period was longer than the first one ( p = 0.012). Characteristics of cluster headache decreased over time: Side-locked unilaterality (from 92.9% to 78.9%), seasonal and circadian rhythmicity (from 63.9% to 60.9% and from 62.2 to 40.5%, respectively), and autonomic symptoms (from 95.2% to 75.0%). Remission occurred in 14 (33.3%) patients at a mean age of 42.3 (range, 27–65) years, which was not different from the age of last bouts in active patients ( p = 0.623). There was a trend for more seasonal and circadian predilection at baseline in the active group ( p = 0.056 and 0.063, respectively) and fewer lifetime bouts and shorter disease duration in patients in remission ( p = 0.063 and 0.090). Conclusions This study first shows the natural courses of cluster headache. Features of cluster headache become less prominent over time. Remission occurred regardless of age. Although no single predictor of remission was found, our data suggest that remission of cluster headache might not be a consequence of more advanced age, longer duration of disease, or accumulation of lifetime bouts.

scholarly journals 1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Wong ◽  
R Sehgal ◽  
A Goyal ◽  
D Allen
Keyword(s):  
Discharge Summary ◽  
Sufficient Information ◽  
Health Seeking ◽  
Post Intervention ◽  
Discharge Letter ◽  
Red Flag ◽  
Considerable Morbidity ◽  
Lost To Follow Up

Abstract Introduction Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents. Method A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up. Results Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%. Conclusions Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.

scholarly journals The cost and effect of expanding a Patient Tracer programme to identify and return patients loss to follow up at a large HIV Clinic in Trinidad

2020 ◽  
Author(s):  
R. Jeffrey Edwards ◽  
Nyla Lyons ◽  
Wendy Samaroo-Francis ◽  
Leon-Omari Lavia ◽  
Isshad John ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Treatment Clinic ◽  
The Status ◽  
Clinic Medical ◽  
The Cost ◽  
Lost To Follow Up ◽  
Over Time

Abstract Background: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study evaluated the effect and cost of expanding an intervention using two Patient Tracers to track and return to care patients lost to follow up at a large HIV Clinic in Trinidad.Methods: Two Social Workers were trained as Patient Tracers and hired initially for 6 months (April –September 2017), then extended to 15 months (April 2017 – June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016 – May 2018 at the HIV Clinic Medical Research Foundation of Trinidad and Tobago. Both the outcomes of the intervention, and costs were assessed over time. Results: Over the 15 month period, of the of 2,473 patients who missed their scheduled visits for one month or more, 261 (10.6%) patients were no longer in active care - 89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2,212 patients eligible for tracing, 1,794 (81.1%) patients were returned to care at an average cost of $38.09 USD per patient returned to care as compared to 589 of 866 (68%) patients returned to care over the 6 month period (p < 0.001) at an estimated cost of $47.72 USD per patient returned to care (p<0.001). Of the 1,794 patients returned to care, 1,686 (94%) were re-initiated/started on anti-retroviral therapy and 72.7% of these were virally suppressed (viral load <1,000 copies/ml) as of December 2018.Conclusions: Patient Tracing is a feasible and effective intervention to identify and resolve the status of patients who are loss to follow up to bring these patients back into care with the aim of achieving viral suppression on antiretroviral therapy. Over time the effect of costs of patients returned to care demonstrated greater yields making patient tracing a sustainable intervention for programmes to identify and return patients to care.

CLIPPERS and its mimics: evaluation of new criteria for the diagnosis of CLIPPERS

2019 ◽  
Vol 90 (9) ◽  
pp. 1027-1038 ◽  
Author(s):  
Guillaume Taieb ◽  
Patricia Mulero ◽  
Dimitri Psimaras ◽  
Bob W van Oosten ◽  
Jörg D. Seebach ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Disease Onset ◽  
Brain Biopsy ◽  
Red Flags ◽  
Non Invasive ◽  
Daily Dose ◽  
Red Flag ◽  
New Criteria

ObjectiveTo evaluate the accuracy of the recently proposed diagnostic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS).MethodsWe enrolled 42 patients with hindbrain punctate and/or linear enhancements (<3 mm in diameter) and tested the CLIPPERS criteria.ResultsAfter a median follow-up of 50 months (IQR 25–82), 13 out of 42 patients were CLIPPERS-mimics: systemic and central nervous system lymphomas (n=7), primary central nervous system angiitis (n=4) and autoimmune gliopathies (n=2). The sensitivity and specificity of the CLIPPERS criteria were 93% and 69%, respectively. Nodular enhancement ( ≥ 3 mm in diameter), considered as a red flag in CLIPPERS criteria, was present in 4 out of 13 CLIPPERS-mimics but also in 2 out of 29 patients with CLIPPERS, explaining the lack of sensitivity. Four out of 13 CLIPPERS-mimics who initially met the CLIPPERS criteria displayed red flags at the second attack with a median time of 5.5 months (min 3, max 18), explaining the lack of specificity. One of these four patients had antimyelin oligodendrocyte glycoprotein antibodies, and the three remaining patients relapsed despite a daily dose of prednisone/prednisolone ≥ 30 mg and a biopsy targeting atypical enhancing lesions revealed a lymphoma.ConclusionsOur study highlights that (1) nodular enhancement should be considered more as an unusual finding than a red flag excluding the diagnosis of CLIPPERS; (2) red flags may occur up to 18 months after disease onset; (3) as opposed to CLIPPERS-mimics, no relapse occurs when the daily dose of prednisone/prednisolone is ≥ 30 mg; and (4) brain biopsy should target an atypical enhancing lesion when non-invasive investigations remain inconclusive.

scholarly journals Peritumoral cysts associated with pituitary macroadenoma

2015 ◽  
Vol 123 (3) ◽  
pp. 789-793 ◽  
Author(s):  
Ryan F. Herde ◽  
Nguyen Hoang ◽  
Diem Kieu Tran ◽  
Genevieve Couldwell ◽  
William T. Couldwell ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Tumor Resection ◽  
Pituitary Macroadenoma ◽  
Lateral Extension ◽  
Predictable Pattern ◽  
Mri Scans ◽  
Fluid Collections ◽  
Lost To Follow Up ◽  
Pituitary Macroadenomas

OBJECT Peritumoral cysts are benign nonneoplastic cysts that are found adjacent to extraaxial brain tumors such as meningiomas, schwannomas, craniopharyngiomas, and esthesioneuroblastomas. Peritumoral cysts associated with pituitary macroadenomas have not been previously described in the literature. The authors report 6 cases of giant macroadenoma-associated peritumoral cysts and delineate their imaging spectrum. METHODS The authors retrospectively reviewed the records of 179 patients diagnosed with pituitary macroadenomas who underwent tumor resection at their institution and had preoperative MRI scans available for review. The patients were evaluated for the presence of associated peritumoral cysts. Clinical presentation, histopathology, follow-up time, tumor and peritumoral cyst dimensions were recorded. Signal intensity on T1-weighted, T2-weighted, diffusion-weighted, and FLAIR sequences, as well as pre- and postcontrast appearance, were determined. RESULTS Six patients (3.4%) with associated peritumoral cysts were identified in our cohort of 179 patients with pituitary macroadenoma. Twelve patients in the cohort had giant macroadenomas (≥ 4.0 cm), and 50% of these tumors had associated peritumoral cysts with significant extrasellar extension of the macroadenoma. Only tumors with craniocaudal, transverse, and anteroposterior diameters of 3.6 × 3.4 × 4.2 cm to 7.0 × 7.4 × 6.8 cm (mean 5.3 × 5.1 × 5.6 cm), respectively, had associated peritumoral cysts. The growth pattern in all tumors was suprasellar, with predominant anterior and lateral extension. Cysts showed T1-weighted, T2-weighted, and FLAIR hyperintensity in 67%, 67%, and 60% of patients, respectively. There was no contrast enhancement of the cyst wall or fluid contents in any patient. Postoperatively, cysts had completely resolved (4 of 5) or significantly decreased in size (1 of 5). One patient was lost to follow-up. CONCLUSIONS Macroadenoma-associated peritumoral cysts are rare, benign, and likely nonneoplastic fluid collections that do not represent neoplasm. These cysts display a predictable pattern of hyperintensity on T1-weighted, T2-weighted, and FLAIR sequences and do not enhance. They most likely represent proteinaceous CSF in a sulcus or cistern that becomes trapped (encysted) by anterolateral extension of unusually large macroadenomas. Peritumoral cysts may facilitate resection of the associated macroadenoma by providing a cleavage plane.

scholarly journals Long-term serological follow-up after primary Coxiella burnetii infection in patients with vascular risk factors for chronic Q fever

2021 ◽  
Author(s):  
Sheila B. Buijs ◽  
Sanne K. Stuart ◽  
Jan Jelrik Oosterheert ◽  
Steffi Karhof ◽  
Andy I. M. Hoepelman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Q Fever ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Serological Testing ◽  
Chronic Q Fever ◽  
Lost To Follow Up

AbstractWe evaluated the long-term serological follow-up of patients with vascular risk factors for chronic Q fever that were previously Coxiellaburnetii seropositive. C. burnetii phase I IgG titers were reevaluated in patients that gave informed consent or retrospectively collected in patients already deceased or lost to follow-up. Of 107 patients, 25 (23.4%) became seronegative, 77 (72.0%) retained a profile of past resolved Q fever infection, and five (4.7%) developed chronic Q fever. We urge clinicians to stay vigilant for chronic Q fever beyond two years after primary infection and perform serological testing based on clinical presentation.

Retrospective comparison of the original and revised McDonald criteria in a general neurology practice in Ireland

2008 ◽  
Vol 14 (1) ◽  
pp. 81-85 ◽  
Author(s):  
J.C. McHugh ◽  
P.L. Galvin ◽  
R.P. Murphy
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Diagnosis ◽  
Accurate Diagnosis ◽  
General Neurology ◽  
Clinical Notes ◽  
Clinically Isolated Syndromes ◽  
Mcdonald Criteria ◽  
Retrospective Comparison

Background The McDonald criteria were introduced in 2001 as guidelines to facilitate early and accurate diagnosis of multiple sclerosis (MS). They were revised in 2005. Although validated in a number of research-focused clinical centres, their adequacy and utility in the general neurology setting is less certain. Objective In this study, we assessed new diagnoses of MS in our practice for compliance with both the original and the revised criteria. Methods We retrospectively identified new diagnoses of MS from 2001. Clinical notes and imaging were evaluated for compliance with McDonald criteria. Results Sixty-two patients were included: 53 with `practice-definite' and nine with `practice-possible' diagnoses of MS. At the time of diagnosis, 47% of the `practice-definite' group fulfilled the 2001 criteria and 49% the revised criteria. Among patients not satisfying the criteria at time of diagnosis, 21% went on to fulfil the McDonald criteria over the 23-month follow-up. Conclusions There is a considerable gap between the clinical diagnosis of MS in a general neurology setting and compliance with the McDonald criteria. Failure to perform follow-up MRI on patients with clinically isolated syndromes is a sizeable factor in this diagnostic-gap and needs to be improved. In this setting, practical differences between the original and revised criteria appear to be small.

scholarly journals THE STATUS OF THE UNAFFECTED EYE IS A PREDICTOR OF SHORT-TERM RECOVERY IN A CROATIAN COHORT OF PATIENTS WITH MONOCULAR OPTIC NEURITIS

2021 ◽  
Vol 65 (2) ◽  
Author(s):  
Marija Jelić Vuković ◽  
◽  
Suzana Matić ◽  
Josip Barać ◽  
Dubravka Biuk ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Clinical Presentation ◽  
Demographic Data ◽  
Short Term ◽  
Severe Attack ◽  
Fellow Eye ◽  
Male Ratio ◽  
The Status ◽  
Lost To Follow Up

Aim: To define the clinical profile of patients with unilateral optic neuritis (ON) presented to our clinic and to identify baseline clinical features and demographic data associated with one-month visual acuity (VA) outcome. Methods: Patients with suspected ON referred to our clinic were consecutively assessed for inclusion between February 2017 and November 2019. VA was measured using Snellen charts. Clinical and demographic, baseline and after one-month follow-up data were analyzed in a multivariate model. Results: Overall, 71 patients were included, of which six were considered lost to follow-up. The median age was 50 years old (interquartile range 37-57 years old) and the female to male ratio was 3:1. 14.1 % had a severe attack and 83.1 % recovered completely one month after the diagnosis. Multivariate analysis of data from 65 patients showed that baseline VA of the affected eye (P=0.011) and fellow eye (P=0.015) were factors associated with VA of the affected eye at follow up. Conclusion: Our cohort was older, had a higher female to male ratio and on average, a less severe ON clinical presentation compared to reports from other countries. Baseline VA of both the affected and fellow eye are predictors of one-month VA recovery

Cranial Chordomas: Clinical Presentation and Results of Operative and Radiation Therapy in Twenty-six Patients

Neurosurgery ◽  
1985 ◽  
Vol 17 (5) ◽  
pp. 703-710 ◽  
Author(s):  
Corey Raffel ◽  
Donald C. Wright ◽  
Philip H. Gutin ◽  
Charles B. Wilson
Keyword(s):  
Radiation Therapy ◽  
San Francisco ◽  
Clinical Presentation ◽  
Average Length ◽  
Heavy Charged Particles ◽  
Presenting Symptoms ◽  
Average Survival ◽  
The University ◽  
Lost To Follow Up

Abstract The clinical presentation and the results of operative and radiation therapy in a series of 26 patients with cranial chordomas seen at the University of California, San Francisco, between 1940 and 1984 are reviewed. There were 14 men and 12 women, with a mean age of 39.6 years. Six patients had chondroid chordomas. The most common presenting symptoms were headache and diplopia, and the most common presenting sign was extraocular palsy. Fifty-three operations directed at removal of the tumor were performed. Twenty-three patients received various forms of radiation therapy postoperatively, including conventional external beam therapy, heavy charged particles, and interstitial implants. The average length of follow-up is 5.6 years. Eleven of 26 patients have died; the mean duration of survival in this group, excluding 1 perioperative death, was 4 years and 2 months. Although the average survival time of 6 years and 4 months was the same in patients with typical chordomas (excluding the perioperative death and 1 patient lost to follow-up) and in those with the chondroid variant, all of the latter are still alive, whereas more than half of the patients with typical chordoma have died.

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