Patient’s travel distance to specialised cancer diagnostics and the association with the general practitioner’s diagnostic strategy and satisfaction with the access to diagnostic procedures: an observational study in Denmark

Abstract Background: Patients with cancer often consult their general practitioner (GP) prior to the diagnosis. Thus, actions taken by the GP are crucial for optimisation of cancer care. This study aimed to investigate the association between cancer patient’s travel distance to the first specialised diagnostic investigation and the GP’s diagnostic strategy and satisfaction with the waiting time and the availability of diagnostic investigations.Method: This combined questionnaire- and registry-based study included incident cancer patients diagnosed in the last six months of 2016 where the GP had been involved in the diagnostic process of the patients prior to their diagnosis of cancer (n=3,455). The patient’s travel distance to the first specialised diagnostic investigation was calculated by ArcGIS Network Analyst. The diagnostic strategy of the GP and the GP’s satisfaction with the waiting times and the available investigations were assessed from GP questionnaires. Results: The patient’s travel distance to the first specialised diagnostic investigation was not associated with the diagnostic strategy of the GP. However, when the GP did not suspect cancer or serious illness, a tendency was seen that longer travel distance to the first specialised diagnostic investigation increased the likelihood of the GP using ’wait-and-see’ approach and ’medical treatment’ as diagnostic strategies. The GPs of patients with travel distance longer than 49 kilometres to the first specialised diagnostic investigation were more likely to report dissatisfaction with the waiting time for requested diagnostic investigations (PRR: 1.98, 95% CI: 1.20-3.28).Conclusion: A tendency to use ‘wait-and-see’ and ‘medical treatment’ were more likely in GPs of patients with long travel distance to the first diagnostic investigation when the GP did not suspect cancer or serious illness. Long distance was associated with higher probability of GP dissatisfaction with the waiting time for diagnostic investigations.

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Patient’s travel distance to specialised cancer diagnostics and the association with the general practitioner’s diagnostic strategy and satisfaction with the access to diagnostic procedures: an observational study in Denmark

10.21203/rs.2.24205/v2 ◽

2020 ◽

Author(s):

Line Flytkjær Virgilsen ◽

Line Hvidberg ◽

Peter Vedsted

Keyword(s):

Medical Treatment ◽

Waiting Time ◽

Travel Distance ◽

Diagnostic Process ◽

Diagnostic Strategy ◽

Long Distance ◽

Serious Illness ◽

Diagnostic Facility ◽

Wait And See ◽

Diagnostic Investigations

Abstract Background: Research indicate that when general practitioners (GPs) refer their patients for specialist care, the patient often has long distance. This study had a twofold aim: in accordance to the GP’s suspicion of cancer, we investigated the association between: 1) cancer patient’s travel distance to the first specialised diagnostic facility and the GP’s diagnostic strategy and 2) cancer patient’s travel distance to the first specialised diagnostic facility and satisfaction with the waiting time and the availability of diagnostic investigations.Method: This combined questionnaire- and registry-based study included incident cancer patients diagnosed in the last six months of 2016 where the GP had been involved in the diagnostic process of the patients prior to their diagnosis of cancer (n=3,455). The patient’s travel distance to the first specialised diagnostic facility was calculated by ArcGIS Network Analyst. The diagnostic strategy of the GP and the GP’s satisfaction with the waiting times and the available investigations were assessed from GP questionnaires. Results: When the GP did not suspect cancer or serious illness, an insignificant tendency was seen that longer travel distance to the first specialised diagnostic facility increased the likelihood of the GP using ’wait-and-see’ approach and ’medical treatment’ as diagnostic strategies. The GPs of patients with travel distance longer than 49 kilometres to the first specialised diagnostic facility were more likely to report dissatisfaction with the waiting time for requested diagnostic investigations (PR: 1.98, 95% CI: 1.20-3.28).Conclusion: A insignificant tendency to use ‘wait-and-see’ and ‘medical treatment’ were more likely in GPs of patients with long travel distance to the first diagnostic facility when the GP did not suspect cancer or serious illness. Long distance was associated with higher probability of GP dissatisfaction with the waiting time for diagnostic investigations.

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Observational Study of the Association Between Tongue Exam and the Kampo Diagnostic Procedure of Fuku Shin (Abdominal Exam) in Blood Stasis

Journal of Evidence-Based Complementary & Alternative Medicine ◽

10.1177/2156587217716215 ◽

2017 ◽

Vol 22 (4) ◽

pp. 879-882 ◽

Cited By ~ 1

Author(s):

Young-Chang Arai ◽

Shuichi Aono ◽

Izumi Makino ◽

Makoto Nishihara ◽

Tatsunori Ikemoto ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Observational Study ◽

Diagnostic Procedure ◽

Severe Disease ◽

Blood Stasis ◽

Diagnostic Procedures ◽

Positive Correlation ◽

Abdominal Region ◽

The Relationship

Blood stasis is a very important pathophysiological concept not only in Kampo but also in traditional Chinese medicine. Blood stasis indicates severe disease. Fuku shin (the abdominal exam) and Zetsu shin (the tongue exam) are the most important approaches of the 4 diagnostic procedures in Kampo. Tenderness of the lower abdominal region ( Sho fuku koh man) and distended sublingual veins have been mentioned as typical signs of blood stasis in Kampo or traditional Chinese medicine. The aim of the present study was to determine the association between Sho fuku koh man and distended sublingual veins. An appearance of sublingual veins and a level of Sho fuku koh man showed a significant and positive correlation ( rs = .5248; n = 279; P < .0001). In conclusion, the relationship between the appearance of sublingual veins and the level of Sho fuku koh man showed a significant and positive correlation.

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Travel distance and sociodemographic correlates of potentially avoidable emergency department visits in California, 2006–2010: an observational study

International Journal for Equity in Health ◽

10.1186/s12939-015-0158-y ◽

2015 ◽

Vol 14 (1) ◽

Cited By ~ 19

Author(s):

Brian K Chen ◽

James Hibbert ◽

Xi Cheng ◽

Kevin Bennett

Keyword(s):

Emergency Department ◽

Observational Study ◽

Emergency Department Visits ◽

Travel Distance ◽

Sociodemographic Correlates

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Diagnostic Strategies for Postmenopausal Bleeding

Obstetrics and Gynecology International ◽

10.1155/2010/850812 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 22

Author(s):

M. C. Breijer ◽

A. Timmermans ◽

H. C. van Doorn ◽

B. W. J. Mol ◽

B. C. Opmeer

Keyword(s):

Endometrial Carcinoma ◽

Diagnostic Procedures ◽

Clinical Problem ◽

Endometrial Biopsy ◽

Diagnostic Workup ◽

Transvaginal Sonography ◽

Future Research ◽

Diagnostic Strategy ◽

Postmenopausal Bleeding ◽

Diagnostic Strategies

Postmenopausal bleeding (PMB) is a common clinical problem. Patients with PMB have 10%–15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS) is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy) can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

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Prevalence of therapeutic and diagnostic procedures in the last 14 days of life in hospital patients: a single-center observational study from Germany

Annals of Palliative Medicine ◽

10.21037/apm-20-2435 ◽

2021 ◽

Vol 10 (4) ◽

pp. 28-28

Author(s):

Burkhard Dasch ◽

Peter K. Zahn

Keyword(s):

Observational Study ◽

Diagnostic Procedures ◽

Single Center ◽

Hospital Patients ◽

Single Center Observational Study

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Comparison two blood culture bottles for the recovery of Enterobacteriaceae

Revista Española de Quimioterapia ◽

10.37201/req/154.2020 ◽

2021 ◽

Author(s):

Ana De Malet ◽

◽

Marisol García-Merino ◽

Silvia Velasco ◽

Carlos Ruiz de Alegría Puig

Keyword(s):

Blood Culture ◽

Observational Study ◽

Recovery Rate ◽

Prospective Observational Study ◽

Diagnostic Strategy ◽

Detection Time ◽

Critical Patients

Introduction. The objective of the present study was to compare the suitability of the B BACTEC™ Lytic/10 Anaerobic/F versus B BACTEC™ Plus Aerobic/F vials at the time of both Enterobacteriaceae recovery rate and detection time. Material and methods. Prospective observational study from September 2018 to January 2019 in which 150 bacteremia. The samples were incubated in the automated BD BACTEC ™ FX system (Becton Dickison). Results. A total of 180 Enterobacteriaceae were isolated: 93 B BACTEC™ Plus Aerobic/F and 87 from B BACTEC™ Lytic/10 Anaerobic/F belonging to 106 patients The urinary focus was the most frequent origin. The average detection time in both cases was not more than 15 hours. Conclusion. The combination of both bottles seems to be the best diagnostic strategy, thus reducing the detection time as well as increasing the recovery of Enterobacteriaceae. The combination of both vials could be implemented especially in selected situation of special urgency such as the sepsis code or critical patients.

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Assessment of a Diagnostic Strategy Based on Chest Computed Tomography in Patients Hospitalized for COVID-19 Pneumonia: an observational study

10.1101/2020.06.29.20140129 ◽

2020 ◽

Author(s):

Marine Thieux ◽

Anne-Charlotte Kalenderian ◽

Aurélie Chabrol ◽

Laurent Gendt ◽

Emma Giraudier ◽

...

Keyword(s):

Computed Tomography ◽

Observational Study ◽

Sensitivity And Specificity ◽

Chest Ct ◽

Time Interval ◽

Diagnostic Strategy ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Pcr Diagnosis ◽

Significant Difference

AbstractObjectivesTo assess the relevance of a diagnostic strategy for COVID-19 based on chest computed tomography (CT) in patients with hospitalization criteria.SettingObservational study with retrospective analysis in a French emergency department (ED).Participants and interventionFrom March 3 to April 2, 2020, 385 adult patients presenting to the ED for suspected COVID-19 underwent an evaluation that included history, physical examination, blood tests, real-time reverse transcription-polymerase chain reaction (RT-PCR) and chest CT. When the time-interval between chest CT and RT-PCR assays was longer than 7 days, patients were excluded from the study. Only patients with hospitalization criteria were included. Diagnosis accuracy was assessed using the sensitivity and specificity of RT-PCR.OutcomesSensitivity and specificity of RT-PCR, chest CT (also accompanied by lymphopenia) were measured and were also analyzed by subgroups of age and sex.ResultsAmong 377 included subjects, RT-PCR was positive in 36%, while chest CT was compatible with a COVID-19 diagnosis in 59%. In the population with positive RT-PCR, there were more men (55% vs 37%, p=0.015), a higher frequency of reticular and, or, interlobular septal thickening (53% vs 31%, p=0.02) as well as a higher frequency of bilateral lesion distribution (98% vs 86%, p=0.01) compared to the population with negative RT-PCR. The proportion of lymphopenia was higher in men vs women (47% vs 39%, p=0.03) and varies between patients >80 versus 50-80 and p<0.001).Using CT as reference, RT-PCR obtained a sensitivity of 61%, specificity of 93%. There was a significant difference between CT and RT-PCR diagnosis performance (p<0.001). When CT was accompanied by lymphopenia, sensitivity and specificity of RT-PCR were respectively 71% and 94%. CT abnormalities and lymphopenia provided diagnosis in 29% of patients with negative PCR.ConclusionsChest CT had a superior yield than RT-PCR in COVID-19 hospitalized patients, especially when accompanied by lymphopenia.

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