DaPeCa-2: Implementation of fast-track clinical pathways for penile cancer shortens waiting time and accelerates the diagnostic process – A comparative before-and-after study in a tertiary referral centre in Denmark

2015 ◽  
Vol 50 (1) ◽  
pp. 80-87 ◽  
Author(s):  
Jakob Kristian Jakobsen ◽  
Jørgen Bjerggaard Jensen
Keyword(s):  
Waiting Time ◽  
Penile Cancer ◽  
Fast Track ◽  
Clinical Pathways ◽  
Diagnostic Process ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Before And After ◽  
Before And After Study

scholarly journals Paediatric attendances of the emergency department in a major Irish tertiary referral centre before and after expansion of free GP care to children under 6: a retrospective observational study

2021 ◽  
Vol 5 (1) ◽  
pp. e000862
Author(s):  
Irina Korotchikova ◽  
Sukainah Al Khalaf ◽  
Ewa Sheridan ◽  
Rory O'Brien ◽  
Colin P Bradley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Service ◽  
Observational Study ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Period 2 ◽  
Time Period ◽  
Before And After ◽  
Gp Care

ObjectivesTo examine the characteristics of paediatric attendances to the emergency department (ED) in Cork University Hospital (CUH) before and after the expansion of free general practitioner (GP) care to children under the age of 6 years.DesignThis is a retrospective observational study that used a large administrative dataset.SettingThe study was conducted in major Irish tertiary referral centre that serves a total population of over 1.1 million. It is a public hospital, owned and managed by the health service executive.ParticipantsChildren aged 0–15 years who attended CUH ED during the study period of 6 years (2012–2018) were included in this study (n=76 831).InterventionsFree GP care was expanded to all children aged 0–5 years in July 2015.Main outcome measuresPaediatric attendances to CUH ED were examined before (Time Period 1: July 2012–June 2015) and after (Time Period 2: July 2015–June 2018) the expansion of free GP care to children under 6. Changes in GP referral rates and inpatient hospital admissions were investigated.ResultsPaediatric presentations to CUH ED increased from 35 819 during the Time Period 1 to 41 012 during the Time Period 2 (14.5%). The proportion of the CUH ED attendances through GP referrals by children under 6 increased by over 8% in the Time Period 2 (from 10 148 to 14 028). Although the number of all children who attended CUH ED and were admitted to hospital increased in Time Period 2 (from 8704 to 9320); the proportion of children in the 0–5 years group who attended the CUH ED through GP referral and were subsequently admitted to hospital, decreased by over 3%.ConclusionThe expansion of free GP care has upstream health service utilisation implications, such as increased attendances at ED, and should be considered and costed by policy-makers.

Rigid endoscopic evaluation of conventional curettage adenoidectomy

2010 ◽  
Vol 125 (1) ◽  
pp. 53-58 ◽  
Author(s):  
D Regmi ◽  
N N Mathur ◽  
M Bhattarai
Keyword(s):  
Eustachian Tube ◽  
Endoscopic Evaluation ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Rigid Endoscopy ◽  
Adenoid Tissue ◽  
Incomplete Removal ◽  
Before And After

AbstractObjectives:To evaluate the results of conventional adenoidectomy, using rigid endoscopy of the nasopharynx, and to establish the role of such evaluation in facilitating complete adenoid removal via the curettage technique.Design:Descriptive rigid endoscopic evaluation of the nasopharynx before and after adenoid curettage, and following subsequent endoscopy-assisted adenoidectomy.Setting:Tertiary referral centre.Patients:Forty-one consecutive children with symptomatic adenoid hypertrophy scheduled to undergo adenoidectomy.Results:Rigid endoscopic evaluation indicated that conventional curettage, used alone, failed to completely remove adenoid tissue from the superomedial choanae and anterior vault in all cases; incomplete removal was also seen in other parts of the choanae (in 67.2 per cent of patients), the eustachian tube opening (63 per cent), the nasopharyngeal roof (61.78 per cent) and the fossa of Rosenmuller (61 per cent). Subsequent rigid endoscopy-assisted adenoidectomy successfully removed the residual adenoid tissue from all nasopharyngeal sites, except the eustachian tube opening in two cases.Conclusion:Conventional curettage adenoidectomy misses a substantial amount of adenoid tissue. Rigid endoscopy-assisted adenoidectomy improves this result by enabling localisation of any residual adenoid tissue.

scholarly journals Can virtual autopsy with postmortem CT improve clinical diagnosis of cause of death? A retrospective observational cohort study in a Dutch tertiary referral centre

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018834 ◽  
Author(s):  
Lianne J P Sonnemans ◽  
Bela Kubat ◽  
Mathias Prokop ◽  
Willemijn M Klein
Keyword(s):  
Clinical Diagnosis ◽  
Cause Of Death ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Virtual Autopsy ◽  
Conventional Autopsy ◽  
Before And After ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

ObjectiveTo investigate whether virtual autopsy with postmortem CT (PMCT) improves clinical diagnosis of the immediate cause of death.DesignRetrospective observational cohort study. Inclusion criteria: inhospital and out-of-hospital deaths over the age of 1 year in whom virtual autopsy with PMCT and conventional autopsy were performed. Exclusion criteria: forensic cases, postmortal organ donors and cases with incomplete scanning procedures. Cadavers were examined by virtual autopsy with PMCT prior to conventional autopsy. The clinically determined cause of death was recorded before virtual autopsy and was then adjusted with the findings of virtual autopsy. Using conventional autopsy as reference standard, we investigated the increase in sensitivity for immediate cause of death, type of pathology and anatomical system involved before and after virtual autopsy.SettingTertiary referral centre.Participants86 cadavers that underwent conventional and virtual autopsy between July 2012 and June 2016.InterventionPMCT consisted of brain, cervical spine and chest–abdomen–pelvis imaging. Conventional autopsy consisted of thoracoabdominal examination with/without brain autopsy.Primary and secondary outcome measuresIncrease in sensitivity for the immediate cause of death, type of pathology (infection, haemorrhage, perfusion disorder, other or not assigned) and anatomical system (pulmonary, cardiovascular, gastrointestinal, other or not assigned) involved, before and after virtual autopsy.ResultsUsing PMCT, the sensitivity for immediate cause of death increased with 12% (95% CI 2% to 22%) from 53% (41% to 64%) to 64% (53% to 75%), with 18% (9% to 27%) from 65% (54% to 76%) to 83% (73% to 91%) for type of pathology and with 19% (9% to 30%) from 65% (54% to 76%) to 85% (75% to 92%) for anatomical system.ConclusionWhile unenhanced PMCT is an insufficient substitute for conventional autopsy, it can improve diagnosis of cause of death over clinical diagnosis alone and should therefore be considered whenever autopsy is not performed.

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