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The examination
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
Patients who have a rare disease can be subject to diagnostic delay.18 Evans encourages clinicians to ‘dare to think rare’ in the context of patients in whom patterns emerge that are divergent from the norm.19 The key skill in primary care is not to know all the clinical presentations for the vast number of rare diseases, but to identify patients who have persistent problems for which we have been unable to provide a satisfactory explanation and to take a whole-person approach, coordinating effectively with specialists to arrive at a diagnosis.
Breast Cancer
Published in Andrew Stevens, James Raftery, Breast Cancer Health Care Needs Assessment, 2018
Rapid diagnosis (or one-stop) clinics have been introduced following concerns over diagnostic delay and frequency of hospital visits.86 The costs and benefits of these clinics have not been assessed. Any change in the organization of services has implications for other aspects of the service. Potential disadvantages of rapid diagnosis clinics include relaxation of referral criteria by GPs and increased psychological morbidity secondary to an expedited diagnosis of malignancy.
Screening
Published in Miranda Thurston, Key Themes in Public Health, 2014
In the case of many cancers, prognosis is strongly linked to stage (size as well as the extent to which the cancer has spread) at diagnosis. Comparative studies of cancer survival rates have consistently shown the UK lagging behind other comparable European countries (Sant et al., 2009), as well as Canada and Australia (Foot and Harrison, 2011). Part of the explanation for differences in survival has been the later stage at which cancers were diagnosed. National screening programmes for breast, cervical and bowel cancer, however, aim to increase early detection and improve survival. In the case of cervical cancer, five-yearly screening has been estimated to prevent 63–73 per cent of cancers in women over 50 years (Patnick, 2013). Diagnostic delay is, however, a reflection of whether or not patients attend for screening having been invited, as well as how quickly they are diagnosed and treated by the health care system (Foot and Harrison, 2011). Diagnostic delay is, therefore, a function of individual, doctor and other service factors. Although England is judged to have developed high quality screening programmes, uptake varies considerably by region (Weller and Campbell, 2009).
The path to diagnosis in ALS: delay, referrals, alternate diagnoses, and clinical progression
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2023
Stefan Sennfält, Ulf Kläppe, Sebastian Thams, Kristin Samuelsson, Rayomand Press, Fang Fang, Caroline Ingre
Importantly, we show a substantial clinical progression from the initial health care visit to diagnosis, e.g., an increase from 11.3% to 46.1% of patients in King’s stage 3 or 4. These results are particularly concerning considering that King’s stage is strongly correlated with shorter survival. One study demonstrated a median survival of 28, 13, and 6–8 months at King’s stage 2, 3, and 4, respectively (20). Thus, the time from initial health care visit until diagnosis is a critical period. Even though therapeutic options for ALS are limited, there are many benefits of shortening the diagnostic delay. The first is to provide answers in a timely manner to mitigate the uncertainty and anxiety of patients (13). Second, admission to a multidisciplinary team with a special interest in ALS might increase survival and quality of life by working preventively, anticipating the progression and the difficulties arising (21). Third, patients identified at an early stage have a better chance of being eligible for enrollment in clinical trials (15). Also, diagnostic delay has been associated with increased health care costs (14).
A systematic review and meta-analysis of diagnostic delay in pulmonary embolism
Published in European Journal of General Practice, 2022
R. van Maanen, E. M. Trinks-Roerdink, F. H. Rutten, G. J. Geersing
In total, 12 studies presented a mean delay with standard deviation. Figure 2 shows the forest plot of all 12 studies reporting a mean delay in diagnosing PE. The reported mean delay ranged from 2.5 to 11.9 days. The pooled point estimate of the mean delay was 6.3 days (95% CI 4.8 to 8.2) with a wide prediction interval (95% PI 2.5 to 15.8 days). The mean delay in studies performed in emergency departments was 7.7 days (95% PI 4.6 to 12.8). In our further pre-defined subgroup analyses (i.e. analyses of only studies with a low risk of bias, with a uniform definition of delay, or only using either prospective or retrospective data collection) the prediction intervals remained wide, indicating residual and unexplained heterogeneity. Sixteen studies reported a percentage of patients with diagnostic delay. Thirteen of these fifteen studies categorised delay beyond seven days. More than seven days of delay varied between 18% and 38%. The primary outcomes are presented in Table 1.
Ear canal and middle-ear tumors: a single-institution series of 87 patients
Published in Acta Oto-Laryngologica, 2022
Taija K. Nicoli, Timo Atula, Saku T. Sinkkonen, Jarkko Korpi, Matej Vnencak, Jussi Tarkkanen, Antti A. Mäkitie, Jussi Jero
In this study, detailed survival analyses were not done because of the large number of different histological EAC and MES entities, and because of incomplete survival data. Interestingly, however, all six patients with an AdCC were alive at the end of follow-up despite five patients having a microscopic residual post primary surgery and one patient experiencing a recurrence eight years into follow-up. This may be because all AdCCs received RT for the residual and were under active follow-up. A recent study advocates long-term follow-up for middle ear adenomatous neuroendocrine tumors because the tumors’ high tendency for recurrence and because of their malignant potential [15]. In our experience, the follow-up of EAC/MES AdCC should include regular imaging and continue for a minimum of 10 years, which is in line with a previous study’s recommendations [16]. In a study by Matoba et al., the outcome of surgically treated EAC and MES SCC was better than that of patients who received only RT even in advanced disease [17]. Lechner et al. [18] furthermore note that differentiation of SCC and its staging at presentation appears to have the greatest influence on 5-year survival rates. While five of the ten patients with SCC received post-operative RT in this study, this nor the primary TNM status of the tumor seemed to significantly affect survival. Shortening the diagnostic delay would be the easiest way to improve outcome for patients. Centralization of the management of this patient population to multidisciplinary head and neck centers could, furthermore, improve treatment outcomes.