scholarly journals Impact of COVID-19 on Delays in General Practice. A Retrospective Analysis

2021 ◽  
Author(s):  
Henk Schers ◽  
Kees van Boven ◽  
Reinier Akkermans ◽  
Chris van Weel ◽  
Tim olde Hartman ◽  
...  
Keyword(s):  
General Practice ◽  
Help Seeking ◽  
Diagnostic Testing ◽  
Musculoskeletal Symptoms ◽  
Duration Of Symptoms ◽  
Health Symptoms ◽  
Delivery Modes ◽  
Seeking Behavior

Abstract BackgroundFrom the beginning of the COVID-19 pandemic, worries have been exposed about collateral damage to patients’ health through postponed appointments, and delayed diagnostic testing and referrals in general practice.AimTo study delays in presentation and management of health problems in general practice during the first 9 months of the COVID-19 crisis. We aimed at symptoms that were most relevant: COVID-19 related symptoms, cancer-related symptoms, mental health symptoms, and musculoskeletal symptoms. Design and settingRetrospective analysis of routine patient data from a practice based registration network in the Netherlands (population 40.000 patients; 30 GPs).MethodWe compared data from the first nine months of the COVID-19 crisis to the preceding 5 years, and analyzed differences between the periods of time in the duration of symptoms before presentation, and the duration from the first presentation in general practice until diagnostic testing and referrals.ResultsWe found no indications that patients waited longer to contact the FP for newly presented health symptoms; only COVID-19 related symptoms were presented earlier to family practice (p< 0.001). Also, we found no delays in general practice for diagnostic testing or referring to hospital care in 2020.ConclusionsGeneral practice maintained its capability to deliver timely care for newly presented health symptoms during the COVID-19 crisis, despite serious changes in delivery modes: patients have contacted their GPs broadly when it was needed, and do not seem to have postponed their help seeking behavior massively. Follow-up studies are needed to monitor long term consequences also in other health echelons.

scholarly journals SAT0540 ONE-YEAR OUTCOMES AFTER RHEUMATIC IMMUNE-RELATED ADVERSE EVENTS FROM CHECKPOINT INHIBITORS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1227.2-1227
Author(s):  
E. Berard ◽  
T. Barnetche ◽  
L. Rouxel ◽  
C. Dutriaux ◽  
L. Dousset ◽  
...  
Keyword(s):  
Adverse Events ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
Symptomatic Treatment ◽  
Musculoskeletal Symptoms ◽  
Day Range ◽  
One Year

Background:Description and initial management of rheumatic immune-related adverse-events (irAEs) from cancer immunotherapies have been reported by several groups but to date, few studies have evaluated the long-term outcomes and management of rheumatic irAEs (1).Objectives:To describe the long-term management and assess the one-year outcomes of patients who experienced rheumatic immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICI).Methods:This was a single-centre prospective observational study including patients referred for musculoskeletal symptoms while treated with ICI. After baseline rheumatological evaluation defining the clinical entity presented, follow-up visits were organised according to the type and severity of irAE. At one year, persistence of irAE, ongoing treatment, as well as cancer outcomes were assessed.Results:63 patients were included between September 2015 and June 2018. 24 patients (38%) presented with non-inflammatory musculoskeletal conditions managed with short-term symptomatic treatment and did not require specific follow-up. 39 patients (62%) experienced inflammatory manifestations, mimicking either rheumatoid arthritis (RA, n=19), polymyalgia rheumatica (PMR, n=16), psoriatic arthritis (PsA, n=3) and one flare of a preexisting axial spondyloarthritis. Overall, 32 patients (82%) received systemic glucocorticoids, with a median rheumatic dosage of 15mg/day (range: 5-60mg/day). None of the patients had to permanently discontinue ICI therapy for rheumatic irAE. 20 patients (67%) were still receiving glucocorticoids at one year, with a median dosage of 5mg/day (range: 2-20mg/day). Glucocorticoids were more frequently discontinued for patients with RA-like condition (44%) than PMR-like condition (23%), but no other predictive factor of glucocorticoids withdrawal could be identified. At one year, overall survival and progression-free survival were comparable between patients who were still receiving glucocorticoids for rheumatic irAE and patients who have discontinued. Eight patients required csDMARDs.Conclusion:At one year, a majority of patients required long-term low-dose glucocorticoids for chronic rheumatic irAE, which seems not altering oncological control.References:[1]Braaten TJ, Brahmer JR, Forde PM, et al. Immune checkpoint inhibitor-induced inflammatory arthritis persists after immunotherapy cessation. Ann Rheum Dis. 2019 Sep 20.Disclosure of Interests:None declared

Help-Seeking in Depressed Out-patients Following Maintenance Therapy

1976 ◽  
Vol 129 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Myrna M. Weissman ◽  
Stanislav V. Kasl
Keyword(s):  
Maintenance Therapy ◽  
Help Seeking ◽  
Maintenance Treatment ◽  
Suicide Attempts ◽  
Clinical Status ◽  
Subsequent Treatment ◽  
Access To Treatment ◽  
One Year

SummaryThis paper reports on the clinical status, help-seeking and subsequent treatment experiences of 150 women one year after they had completed out-patient maintenance treatment by amitriptyline and/or psychotherapy for a depressive episode.While the majority of patients were asymptomatic at follow-up, a substantial minority had a return of acute symptoms and 2 per cent made minor suicide attempts during the year. Admission to hospital was rare. However, only 30 per cent of the patients did not seek any treatment during the year and the majority received some psychotropic medication.The findings support the long-term need for prompt access to treatment by patients who have recovered from an acute depression.

scholarly journals What are the long-term symptoms and complications of COVID-19: a protocol for a living systematic review

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1455
Author(s):  
Melina Michelen ◽  
Louise Sigfrid ◽  
Lakshmi Manoharan ◽  
Natalie Elkheir ◽  
Claire Hastie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Significant Proportion ◽  
The Body ◽  
Depression And Anxiety ◽  
Policy Makers ◽  
Duration Of Symptoms ◽  
Persistent Symptoms ◽  
New Evidence

Although the majority of patients with COVID-19 will experience mild to moderate symptoms and will recover fully, there is now increasing evidence that a significant proportion will experience persistent symptoms for weeks or months after the acute phase of the illness. These symptoms include, among others, fatigue, problems in breathing, lack of smell and taste, headaches, and also depression and anxiety. It has also become clear that the virus has lasting effects not only on the respiratory system but also on other parts of the body, including the heart, liver, and the nervous system. In this paper we present a protocol for a living systematic review that aims to synthesize the evidence on the prevalence and duration of symptoms and clinical features of post-acute COVID-19 and its long-term complications. The living systematic review will be updated regularly, initially monthly with update cycles under continuous review as the pace of new evidence generated develops through the pandemic. We will include studies that follow up with COVID-19 patients who have experienced persistent mild, moderate or severe symptoms, with no restrictions regarding country, setting, or language. We will use descriptive statistics to analyse the data and our findings will be presented as infographics to facilitate transcription to lay audiences. Ultimately, we aim to support the work of policy makers, practitioners, and patients when planning rehabilitation for those recovering from COVID-19. The protocol has been registered with PROSPERO (CRD42020211131, 25/09/2020).

A Long-Term Follow-Up of the Effect of Repeated Corticosteroid Injections for Stenosing Tenovaginitis

1989 ◽  
Vol 14 (2) ◽  
pp. 242-243
Author(s):  
P. FAUNØ ◽  
H. J. ANDERSEN ◽  
O. SIMONSEN
Keyword(s):  
Success Rate ◽  
Single Injection ◽  
Adult Patients ◽  
Complete Relief ◽  
Duration Of Symptoms ◽  
Associated Diseases ◽  
Long Term Follow Up ◽  
Corticosteroid Injections

Ninety-three consecutive adult patients with stenosing tenovaginitis of 104 digits have been treated by corticosteroid injections repeated at three week intervals up to thrice in partial responders. At follow-up after 3–15 years, partial relapse had occurred in two patients, who now and then experienced triggering but without pain or locking. Complete relief of symptoms was obtained in 76%. There were no complications and the success rate was independent of sex, age, duration of symptoms, the digit involved, or associated diseases. These results are superior to those previously reported following a single injection.

Long-term results after posterior fossa decompression in syringomyelia with adult Chiari Type I malformation

2012 ◽  
Vol 17 (5) ◽  
pp. 381-387 ◽  
Author(s):  
Alex Alfieri ◽  
Giampietro Pinna
Keyword(s):  
Craniocervical Junction ◽  
Long Term Results ◽  
Symptom Duration ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Duration Of Symptoms ◽  
Initial Symptoms ◽  
Csf Leakage

Object There is little information about the long-term effectiveness and complications following decompressive surgery for syringomyelia related to Chiari malformation Type I (CM-I). Methods Examining long-term clinical and radiological follow-up, the authors studied a mixed retrospective and prospective single-institution cohort of 109 consecutive surgically treated adult patients with syringomyelia and CM-I. All patients underwent a standardized surgical protocol: decompression of the craniocervical junction, arachnoid exploration, and shrinkage of the cerebellar tonsils. Factors predicting outcome were investigated. Results The retrospective arm consisted of 41 cases treated between 1990 and 1994, and the prospective arm comprised 68 patients treated between 1994 and 2001. The mean overall age was 45.9 years, and 58.8% of the population was female. The median follow-up period was 12.7 years. The most frequent initial symptoms were pain and sensory and gait disturbances. There was no perioperative death or neurological deterioration. The comprehensive perioperative complication rate was approximately 11%, with 3 cases (2.7%) of CSF leakage. Regression analysis showed that the best combination of clinical and radiological outcome predictors was age and duration of symptoms. Clinical follow-up confirmed surgical result stability with clinical improvement of greater than 90% of the spinal and cranial manifestations over a long-term period. Two patients had radiological recurrences of syringomyelia without clinical signs 85 and 124 months after surgery. Conclusions Certain clinical predictors of poor clinical and radiological prognosis were identified—namely, age at time of surgery and symptom duration. The results of the study provide additional long-term data that support the effectiveness and safety of relieving CSF block at the craniocervical junction in CM-I–related syringomyelia.

Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation

1991 ◽  
Vol 74 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Richard L. Saunders ◽  
Philip M. Bernini ◽  
Thomas G. Shirrefks ◽  
Alexander G. Reeves
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Consecutive Series ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Long Duration ◽  
Swallowing Dysfunction ◽  
Long Term Follow Up ◽  
Perioperative Complication

✓ Since 1984, a consecutive series of patients with cervical spondylotic myelopathy has been treated by central corpectomy and strut grafting. This report focuses on 40 cases operated on between 1984 and 1987 and followed from 2 to 5 years. The perioperative complication rate was 47.5%, with a 7.5% incidence of persistent sequelae: severe C-5 radiculopathy in one patient, swallowing dysfunction in one, and hypoglossal nerve palsy in one. No single factor (age, duration of symptoms, or severity of myelopathy) was absolutely predictive of outcome; however, syndromes of short duration had the best likelihood of cure. Similar outcomes were associated, individually, with long duration of symptoms, age over 70 years, and severe myelopathy. After factoring a 5% regression of improvement, the long-term cure rate was 57.5% and the failure rate was 15%. Myelopathy worsening was not documented.

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