Delayed referral for orchidopexy: Scrutinising the causes

Orchidopexy for undescended testis is recommended at a younger age than heretofore; our study aimed to assess delays, and their causes, by retrospective analysis of data from a single tertiary care centre over one year (2015–2016). Almost 80% of children were brought after 1 year of age, mostly because of delayed referral by primary physicians (60%), or missed diagnosis by parents or primary physicians (20%). Misconception about the risk of surgery below 1 year was significant (15%). A timely referral is encouraged.

Acute Mesenteric Ischemia in a COVID-19 Patient: Delay in Referral and Recommendation for Surgery

Coronavirus (COVID-19) is more common with symptoms such as fever, dry cough, and shortness of breath. However, it may be associated with COVID-19-induced gastrointestinal (GI) symptoms including acute mesenteric ischemia (AMI). These conditions make the diagnosis of AMI challenging. Timely referral with correct diagnosis and attention to the uncommon symptoms of COVID-19 can play an important role in the management and treatment of AMI in COVID-19 patients. We present a patient with AMI due to thrombotic complications of COVID-19, who referred to the hospital too late and ignored the recommendation for abdominal surgery.

Separación Madre - Recién Nacido hospitalizado en pandemia: Un acontecimiento para reflexionar

RESUMENLa pandemia por el virus SARS-CoV-2, ha provocado cambios en los protocolos de atención en todos los servicios del país, incluidas las unidades de neonatología, dificultando la cercanía entre las madres y sus recién nacidos, y poniendo en riesgo la generación del vínculo y posterior apego seguro entre el niño y la madre. La hospitalización neonatal, gatilla en las madres afecciones psicoemocionales, debidas principalmente por la consecuente separación. Existe evidencia del impacto que genera en las madres la hospitalización neonatal durante el período de pandemia. Se visualiza la insuficiencia de protocolos establecidos para permitir la cercanía materna con el neonato en contexto de pandemia, por lo que se plantea la necesidad de replantear los protocolos de visita y definir estrategias de detección precoz de alteraciones de salud mental en las madres que han sido separadas de sus neonatos. Se efectúa una reflexión respecto de las acciones, prioridades y desafíos que las matronas y matrones debemos considerar para velar por el bienestar del binomio. Así como la detección a nivel primario de salud, mediante acciones de matronería, que parece ser una intervención ética.Palabras Claves: SARS-CoV-2; Salud Materna, Cuidado Perinatal, Matronería.ABSTRACTThe pandemic caused by the SARS-CoV-2 virus has caused changes in the care protocols in all the neonatology units, making it difficult for mothers and their newborns to be close. And, is a risk of generating a healthy bond and subsequent sure attachment between the child and the mother. Neonatal hospitalization triggers psycho-emotional conditions in mothers, mainly due to the consequent separation.Was identified publications related to the experience of mothers of hospitalized newborns during the pandemic period. In addition, fundamental aspects of the mothers' mental health are pointed out during this parenting period. A reflection is proposed regarding the actions, priorities, and challenges that midwives must consider to ensure the well-being of the couple, especially in the context of a pandemic. The insufficiency of established protocols to care for the mental health of mothers of hospitalized newborns is visualized, for which reason early detection strategies and timely referral to the health care network are proposed for mothers who have been separated from their neonates. Detection at the primary health care level, through midwifery actions, seems to be an ethical intervention.Key Words: SARS-CoV-2; Maternal Health; Perinatal Care; Midwifery.

Structured Counselling and Regular Telephonic Follow Up among Diabetic Retinopathy Patients to improve Timely Referral Flow and Compliance from peripheral eye care centre to tertiary centre in Nepal: A Randomised Controlled Trial (Preprint)

BACKGROUND Diabetic Retinopathy (DR) is an emerging public health issue. DR may lead to severe visual impairment or blindness. Referral communication and tracking system is helpful to monitor patients flow, timeliness and compliance; ensures a close relationship across health facilities and improves patient’s satisfaction. The aim of the study is to improve timely referral flow and compliance of patients diagnosed with DR. OBJECTIVE Primary objective: To assess the effect of intervention on timely referral compliance Secondary objectives: To assess the determinants and cost effectiveness of the intervention for timely referral compliance. METHODS This is an operational research study using cluster randomized controlled health facility-based trial. A situational analysis was conducted and problem tree was developed to identify different barriers to referral compliance (long waiting time, lack of knowledge about diabetic retinopathy, its impact on vision and different treatment options).Appropriate solutions were identified through comprehensive literature review and addressing individual barriers to improve poor referral and compliance of patients diagnosed with DR from peripheral centres (referring centre). These solutions were systemically arranged in the form of an intervention package, which will be tested using a cluster-based randomized controlled trial. Ten eligible peripheral hospitals out of 19will be randomly selected and allocated (lottery method); five each in intervention and control groups. Structured counselling and referral communication linkage will be implemented to the intervention group. Structured counselling, health educational material, and telephonic follow-up will be provided by a trained counsellor at the referring centre; patients will be told in detail about DR, its impact on eyes and vision, treatment options available and the treatment cost for different procedures. They will be explained process at LEIRC (referral centre) and a contact person shall facilitate their treatment at the referral centre. Patients in Control group will receive ongoing routine counselling and health education material. We collected data on referral and compliance, and their determinants using referral-and DR-registers, and structured questionnaires for 1.demographic and socioeconomic profile of patients, 2.telephonicfollow-up with noncompliant patients,3.Feedback of those referred, and 4.Performa for clinical information. Compliance is considered when the referred participant reports at referral centre within one month of counselling. Referral compliance between the two groups will be compared using appropriate statistical tests. Adjusted analysis will be conducted. RESULTS Due to COVID-19 pandemic the inflow of patients is reduced, thus the duration of the data collection will be increased. In the first 6 months of pilot data collection73 in intervention and 34 in control group were screened for referral; 12(21.82%) and 15(27,2%) already had severe NPDR or PDR at the time of screening. CONCLUSIONS Early stage of DR is asymptomatic and can go unnoticed until it affects vision leading to visual impairment and blindness. This study will assess the feasibility and effectiveness of a referral intervention package for improving early diagnosis and treatment with preservation of vision among DR patients. CLINICALTRIAL Clinicaltrials.gov NCT 04834648

TP6.2.16General practitioner compliance with Scottish cancer referral guideline for Oesophago-gastric cancer

Aims The outcome of oesophago-gastric cancer is often poor. Timely referral of suspected cancer is essential for early diagnosis and optimal outcome. This study aims to audit the General Practitioners (GPs) compliance with the Scottish referral guidelines for suspected oesophago-gastric cancer. Methods A retrospective cohort study of all newly diagnosed oesophago-gastric cancers who were referred from the primary care and discussed in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and symptomatology audited against the Scottish cancer referral guidelines. Results Of the 349 patients, 227 (65.0%) were referred from the primary care. 150 (66.1%) were male and the mean age was 69.5 ± 10.9 years. Mean Scottish Index of Multiple Deprivation was 5 ± 3. 149 (65.6%) had dysphagia and/or odynophagia and 181 (79.7%) were oesophageal cancers. 67 (29.5%) were T4 disease and 87 (38.3%) were metastatic at presentation. Urgency of referral was: 25 (11.0%) routine, 54 (23.7%) urgent and 148 (65.2%) Urgent Suspicion of Cancer (USOC). 192 (84.6%) patients qualified to be referred as USOC, of these 138 (71.9%) were actually referred as USOC. Of the 35 (15.4%) patients who did not qualify for the USOC referral, 10 (28.6%) patients were referred as USOC. The sensitivity was 71.9% and specificity 71.4%. Conclusions GP compliance with the adherence with the National guidelines remains a barrier in the USOC in oesophago-gastric cancer. Further GP education and awareness is required to improve their compliance.

The cardiac amyloidosis clinical pathway implementation: a real world experience

Background/Introduction Prognosis for patients with cardiac amyloidosis (CA) is determined by disease stage at diagnosis, underlining the importance of timely referral. In 2018, a CA clinical pathway was implemented in an Amyloidosis Expert Center in The Netherlands to increase regional awareness. Purpose To evaluate the impact of CA clinical pathway implementation. Methods Patients diagnosed before implementation (2007–2018; T1) were retrospectively compared to the period after clinical pathway implementation (2019–2020; T2). Demographics and disease characteristics were collected from electronic health records. Results In total, 113 patients were diagnosed, mean age 67.8±8.5 years, 26% female. AL-CA was diagnosed in 62%, ATTR-CA in 38%. The number of CA diagnoses/year increased over time (Figure 1). NYHA class III (45% vs. 24%,p=0.04), CA stage (MAYO/Gillmore stage III or IV; 59% vs. 33%, p=0.03) and delay between symptoms and diagnosis (14.5 vs. 8.4 months, p<0.01) improved considerably between T1 and T2. Reasons for referral changed over time, with increasing awareness for right ventricular hypertrophy (9% vs. 36%) and unexplained HFpEF (22% vs 38%). Conclusion CA patients were diagnosed earlier with less severe symptoms. Clinical pathway implementation facilitated regional increased awareness and improved timely referral. FUNDunding Acknowledgement Type of funding sources: None.

Listing criteria for heart transplantation in the Netherlands

The updated listing criteria for heart transplantation are presented on behalf of the three heart transplant centres in the Netherlands. Given the shortage of donor hearts, selection of those patients who may expect to have the greatest benefit from a scarce societal resource in terms of life expectancy and quality of life is inevitable. The indication for heart transplantation includes end-stage heart disease not remediable by more conservative measures, accompanied by severe physical limitation while on optimal medical therapy, including ICD/CRT‑D. Assessment of this condition requires cardiopulmonary stress testing, prognostic stratification and invasive haemodynamic measurements. Timely referral to a tertiary centre is essential for an optimal outcome. Chronic mechanical circulatory support is being used more and more as an alternative to heart transplantation and to bridge the progressively longer waiting time for heart transplantation and, thus, has become an important treatment option for patients with advanced heart failure.

The short child: Importance of early detection and timely referral

Stunting is a common phenomenon in Malaysian children. Optimising outcomes for children with growth disorders rests on early recognition and prompt referral. In this context, a framework for the clinical approach can help to guide appropriate growth assessment and referral. This review article aims to provide family medicine specialists with such a framework whilst raising awareness about the shortcomings of the existing growth monitoring system in Malaysia. It also invites readers to consider additional measures that could further optimise this system.

Laryngotracheal stenosis: A more common problem in the COVID era

Laryngotracheal stenosis (LTS) is a rare cause of dyspnoea. It is associated with emergency or prolonged intubation and with tracheostomy. It is expected to increase in incidence following the coronavirus 2019 (COVID-19) pandemic, due to the increased numbers of prolonged intensive care admissions. Presentation may be weeks or even years after the acute episode. A variety of symptoms may be present, and include dyspnoea, cough, dysphagia, stridor or voice change. LTS can be confused with commoner respiratory diseases such as asthma. Awareness of the condition is important to facilitate a timely referral to Otolaryngology for diagnosis and management.