Late Breaking Abstract - Burden of disease, diagnostic work-up and management of bronchiectasis in outpatient clinics – a five-year prospective cohort study

2020 ◽  
Author(s):  
Kjell Erik Julius Håkansson ◽  
Katrine Fjaellegaard ◽  
Andrea Browatzki ◽  
Melda Sin ◽  
Rafal Wiater ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Burden Of Disease ◽  
Prospective Cohort ◽  
Outpatient Clinics ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals General practitioner use of D-dimer in suspected venous thromboembolism: historical cohort study in one geographical region in the Netherlands

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026846 ◽  
Author(s):  
Angel M R Schols ◽  
Eline Meijs ◽  
Geert-Jan Dinant ◽  
Henri E J H Stoffers ◽  
Mariëlle M E Krekels ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Practitioner ◽  
Clinical Assessment ◽  
Geographical Region ◽  
Historical Cohort ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
D Dimer

ObjectivesTo investigate how many general practitioner (GP)-referred venous thromboembolic events (VTEs) are diagnosed during 1 year in one geographical region and to investigate the (urgent) referral pathway of VTE diagnoses, including the role of laboratory D-dimer testing.DesignHistorical cohort study.SettingGP patients of 47 general practices in a demarcated geographical region of 161 503 inhabitants in the Netherlands.ParticipantsWe analysed all 895 primary care patients in whom either the GP determined a D-dimer value or who had a diagnostic work-up for suspected VTE in a non-academic hospital during 2015.Primary and secondary outcome measuresThe primary outcomes of this study were the total number of VTEs per year and the diagnostic pathways—including the role of GP determined D-dimer testing—of patients urgently referred to secondary care for suspected VTE. Additionally, we explored the use of an age-adjusted D-dimer cut-off.ResultsThe annual VTE incidence was 0.9 per 1000 inhabitants. GPs annually ordered 5.1 D-dimer tests per 1000 inhabitants. Of 470 urgently GP-referred patients, 31.3% had a VTE. Of those urgently referred based on clinical assessment only (without D-dimer testing), 73.8% (96/130) had a VTE; based on clinical assessment and laboratory D-dimer testing yielded 15.0% (51/340) VTE. Applying age-adjusted D-dimer cut-offs to all patients aged 50 years or older resulted in a reduction of positive D-dimer results from 97.9% to 79.4%, without missing any VTE.ConclusionsAlthough D-dimer testing contributes to the diagnostic work-up of VTE, GPs have a high detection rate for VTE in patients who they urgently refer to secondary care based on clinical assessment only.

scholarly journals Sensitivity and specificity of routine diagnostic work-up for tuberculosis in lung clinics in Yogyakarta, Indonesia: a cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Antonia Morita I. Saktiawati ◽  
Yanri W. Subronto ◽  
Ymkje Stienstra ◽  
Sumardi ◽  
Fabiola Supit ◽  
...  
Keyword(s):  
Cohort Study ◽  
Sensitivity And Specificity ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Schop ◽  
K. Stouten ◽  
J. A. Riedl ◽  
R. J. van Houten ◽  
M. J. G. Leening ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Practices ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Spectrum of Benign Breast Diseases in Females- a 10 years study

2018 ◽  
Vol 30 (1) ◽  
pp. 16-18
Author(s):  
Shakera Ahmed ◽  
Anisul Awal
Keyword(s):  
Cohort Study ◽  
Clinical Features ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Age Distribution ◽  
Breast Diseases ◽  
Female Patients ◽  
Benign Breast Diseases ◽  
Mode Of Presentation ◽  
Work Up

The study was conducted to determine the frequency of various benign breast diseases in female patients, to analyze the percentage of incidence of benign breast diseases, the age distribution and their different mode of presentation. This is a prospective cohort study of all female patients visiting a female surgeon with benign breast problems. The study was conducted at Chittagong Metropolitn Hospital and CSCR hospital in Chittagong over a period of 10 years starting from July 2007 to June 2017. All female patients visiting with breast problems were included in the study. Patients with obvious clinical features of malignancy or those who on work up were diagnosed as carcinoma were excluded from the study. The findings were tabulated in excel sheet and analyzed for the frequency of each lesion, their distribution in various age group.Medicine Today 2018 Vol.30(1): 16-18

scholarly journals Workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle Spek ◽  
Jochen W. L. Cals ◽  
Guy J. Oudhuis ◽  
Paul H. M. Savelkoul ◽  
Eefje G. P. M. de Bont
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Electronic Patient Records ◽  
Out Of Hours ◽  
Diagnostic Work ◽  
Tract Infections ◽  
Work Up ◽  
Diagnostic Work Up

Abstract Background Urinary tract infections (UTIs) are one of the most common infections in primary care. Previous research showed that GPs find it challenging to diagnose UTIs and frequently divert from guidelines leading to unwarranted antibiotic prescriptions and inefficient use of diagnostics such as urinary cultures. We hypothesise that management of UTIs during out-of-hours care may be extra challenging due to a higher workload and logistical issues regarding diagnostic work-up and obtaining results. We therefore aimed to study the workload, diagnostic work-up and treatment of UTIs during out-of-hours primary care. Methods We performed a retrospective observational cohort study in which we analysed a full year (2018) of electronic patient records of two large Dutch GP out-of-hours centres. All adult patients with UTI symptoms were included in this study. Descriptive statistics and multivariate regression were used to analyse diagnostics and subsequent management. Results A total of 5657 patients were included (78.9% female, mean age of 54 years), with an average of eight patients per day that contact a GP out-of-hours centre because of UTI symptoms. Urinary dipsticks were used in 87.5% of all patients visiting the out-of-hours centres with UTI symptoms. Strikingly, urinary cultures were only requested in 10.3% of patients in which urinary culture was indicated. Seventy-four percent of the patients received antibiotics. Seventy-nine percent of the patients with a negative nitrite test still received antibiotics. Remarkably, patients at risk of complications because of a UTI, such as men, received fewer antibiotic prescriptions. Conclusions In total, 74% of the patients received antibiotics. 8 out of 10 patients still received an antibiotic prescription in case of a negative nitrite test, and 9 out of 10 patients with an indication did not receive a urine culture. In conclusion, we found that correctly diagnosing UTIs and prescribing antibiotics for UTIs is a challenge that needs major improvement, especially during out-of-hours GP care.

scholarly journals Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden

2019 ◽  
Vol Volume 11 ◽  
pp. 231-244 ◽  
Author(s):  
Krister Lindmark ◽  
Kurt Boman ◽  
Mona Olofsson ◽  
Michael Törnblom ◽  
Aaron Levine ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Population Based ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals P162: Patient-important outcomes in hyperglycemia after discharge from the emergency department: a prospective cohort study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S114-S115
Author(s):  
J. W. Yan ◽  
L. Siddiqi ◽  
K. Van Aarsen ◽  
M. Columbus ◽  
K. M. Gushulak
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Healthcare Provider ◽  
Prospective Cohort Study ◽  
Burden Of Disease ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Post Discharge

Introduction: Hyperglycemic emergencies, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS), carry significant morbidity for individuals even after discharge. The objective of this study was to describe the patient-important outcomes and burden of disease for emergency department (ED) patients with hyperglycemia after discharge from hospital. Methods: This was a prospective cohort study of patients 18 years presenting to two tertiary care EDs (combined annual census 150,000 visits) with a discharge diagnosis of hyperglycemia, DKA or HHS over a 15-month period (Jul 2016-Oct 2017). During the ED visit, consent was obtained for a telephone follow-up call to determine patient-important outcomes. Trained research personnel collected data from medical records and completed a 14 day telephone follow-up using a standardized questionnaire to determine medication changes, missed days of school or work, and repeat admissions or visits to a healthcare provider. Descriptive statistics were used where appropriate to summarize the data. Results: Thus far, 172 patients have been enrolled in our study. Mean (SD) age is 53.9 (19.3) years and 97 (56.4%) are male. 65 (37.8%) patients were admitted from their initial ED visit. Of the 125 patients (72.7%) providing post-discharge outcomes, 75 (60.0%) required an adjustment to their diabetes medications or insulin. 21 (16.8%) patients missed days of school or work for a median (IQR) duration of 3.5 (1.3, 7.0) days. 85 (68.0%) saw another healthcare provider within a 14 day period, 45 (36.0%) saw their family physician, and 34 (27.2%) saw an internist or endocrinologist. 9 (7.2%) were seen again in the ED, 5 of these patients required admission to hospital. There was one death that occurred within the follow-up period. Conclusion: This prospective study builds on our previous retrospective work and demonstrates that visits for hyperglycemia carry a significant burden of disease beyond what may be seen in a single ED encounter. Further research will attempt to identify the factors that may be predictive of adverse outcomes in hyperglycemic patients presenting to the ED.

scholarly journals Role of endoscopic ultrasonography in the diagnostic work-up of idiopathic acute pancreatitis (PICUS): study protocol for a nationwide prospective cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e035504
Author(s):  
Devica S Umans ◽  
Hester C Timmerhuis ◽  
Nora D Hallensleben ◽  
Stefan A Bouwense ◽  
Marie-Paule GF Anten ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cohort Study ◽  
Magnetic Resonance ◽  
Endoscopic Ultrasonography ◽  
Medical Center ◽  
First Episode ◽  
Idiopathic Acute Pancreatitis ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

IntroductionIdiopathic acute pancreatitis (IAP) remains a dilemma for physicians as it is uncertain whether patients with IAP may actually have an occult aetiology. It is unclear to what extent additional diagnostic modalities such as endoscopic ultrasonography (EUS) are warranted after a first episode of IAP in order to uncover this aetiology. Failure to timely determine treatable aetiologies delays appropriate treatment and might subsequently cause recurrence of acute pancreatitis. Therefore, the aim of the Pancreatitis of Idiopathic origin: Clinical added value of endoscopic UltraSonography (PICUS) Study is to determine the value of routine EUS in determining the aetiology of pancreatitis in patients with a first episode of IAP.Methods and analysisPICUS is designed as a multicentre prospective cohort study of 106 patients with a first episode of IAP after complete standard diagnostic work-up, in whom a diagnostic EUS will be performed. Standard diagnostic work-up will include a complete personal and family history, laboratory tests including serum alanine aminotransferase, calcium and triglyceride levels and imaging by transabdominal ultrasound, magnetic resonance imaging or magnetic resonance cholangiopancreaticography after clinical recovery from the acute pancreatitis episode. The primary outcome measure is detection of aetiology by EUS. Secondary outcome measures include pancreatitis recurrence rate, severity of recurrent pancreatitis, readmission, additional interventions, complications, length of hospital stay, quality of life, mortality and costs, during a follow-up period of 12 months.Ethics and disseminationPICUS is conducted according to the Declaration of Helsinki and Guideline for Good Clinical Practice. Five medical ethics review committees assessed PICUS (Medical Ethics Review Committee of Academic Medical Center, University Medical Center Utrecht, Radboud University Medical Center, Erasmus Medical Center and Maastricht University Medical Center). The results will be submitted for publication in an international peer-reviewed journal.Trial registration numberNetherlands Trial Registry (NL7066). Prospectively registered.

scholarly journals Causes of fever in Tanzanian adults attending outpatient clinics: a prospective cohort study

2020 ◽  
Author(s):  
N. Boillat-Blanco ◽  
Z. Mbarack ◽  
J. Samaka ◽  
T. Mlaganile ◽  
T. Kazimoto ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Outpatient Clinics
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