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Clinical Presentation and Associated Syndromes of Brain Tumor
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
David A. Walker, Jo-Fen Liu, Dhurgsharna Shanmugavadivel
In this chapter we will illustrate the range of clinical presentations of different tumor types and anatomical presentations across the first 25 years of life to offer examples that can be used for teaching and training of healthcare workers and the public. The current gold-standard diagnostic test is a brain scan, using a magnetic resonance imaging (MRI) scan or contrast-enhanced computed tomography (CT) scan. We will go on to consider the research evidence for the range of symptomatology and patterns of referral leading to diagnosis in different health systems, where they have been studied. We will present evidence of a new population-based symptom awareness program called HeadSmart Early Diagnosis of Brain Tumor (www.headsmart.org.uk), directed at informing the public and profession and selecting patients for urgent imaging to diagnose or exclude brain tumor. In this, we will consider the technical challenge of an awareness campaign, how it could be designed, monitored, and modified to tackle referral practice in a national health system using the guidance from an evidence-based clinical guideline seeking to accelerate brain tumor diagnosis. We will identify initiatives that are in development following the example of the HeadSmart campaign. We will conclude by considering how the priority of accelerating diagnosis could lead to a new era of brain tumor diagnosis, treatment, and outcome with reduced risk of brain injury for survivors.
Changing Roles
Published in David B. Friend, HealthCare.com, 2020
Effectively redefining the role and uses of intellectual capital will be the key to making the new strategies work. Providers will need to migrate from non-cost-conscious, collegial environments to more competitive, yet collaborative, situations. Referrals will need to be made on the basis of value, cost, and quality, not because of the referring physician’s personal relationships with the specialist. Organizational design will need to align provider incentives to attain the highest levels of quality while maximizing value received. Medicine will no longer be able to run as a provincial enterprise. The cottage industry is over. The provider steeped in 13th-century management practices will need to leap forward to the next millennium in order to survive.
A general practitioner’s outlook on long-term hormone replacement therapy and the general practitioner/specialist relationship
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
In the UK it is not usual for patients to have direct access to a specialist. Patients are normally seen first by their GP who may initiate treatment before an appropriate specialist referral is made, if deemed necessary. After consultation with the specialist, specific treatment may be started, but the patient is usually returned to the care of the GP for further management and long-term care. Good liaison between GP and specialist is therefore vital.
“It’s not safe for me and what would it achieve?” Acceptability of patient-referral partner notification for sexually transmitted infections to young people, a mixed methods study from Zimbabwe
Published in Sexual and Reproductive Health Matters, 2023
Joni Lariat, Chido Dziva Chikwari, Ethel Dauya, Valentine T. Baumu, Victor Kaisi, Laura Kafata, Esnath Meza, Victoria Simms, Constance Mackworth-Young, Helena Rochford, Anna Machiha, Tsitsi Bandason, Suzanna C. Francis, Rashida A. Ferrand, Sarah Bernays
Partner notification (PN) is considered an essential component of the management of STIs, to both treat sexual partners and reduce the risk of re-infection in the index case.5 PN is based upon the premise that once an index case has been identified and treated, they represent a unique opportunity to “contact trace” other potential infections that might otherwise remain unidentified. Key PN strategies include “patient-referral” (index case notifies partner), “provider referral” (provider notifies partner), and “expedited partner therapy” (index case provides treatment or prescription to partner).5,6 Provider referral and expedited partner therapy have demonstrated higher efficacy and acceptability than patient-referral in high-income countries.7,8 Provider referral is expensive when compared with patient-orientated strategies, and requires greater infrastructural and personnel capacity.9 While expedited partner therapy is not legal in some settings, it is more cost-effective and has been shown to significantly reduce rates of reinfection.10 However, its use in southern African settings where it is legal and is included in national guidelines (such as in Zimbabwe), is currently limited to trials.10 Patient-referral has remained the most common PN method in the management of STIs in most resource-constrained settings.11
Guidance for clinicians when working with refugees and asylum seekers
Published in International Review of Psychiatry, 2022
Rachel Tribe, Farkhondeh Farsimadan
Clinicians who receive such a referral are encouraged to follow the guidance provided below:1. Show respect for service users and make sure clear information is given about meetings. Dealing with officialdom can often seem unpleasant and hostile. So, it is vital that the clinician considers the health service from the service user’s viewpoint and makes it as accessible as possible. This may be achieved in a number of ways such as: sending a written invitation in the individual’s own language as well as language of the new country, providing your full name, including travel directions, considering the time of the appointment, the lay out of your office etc.
Pathway of care for visual and vestibular rehabilitation after mild traumatic brain injury: a critical review
Published in Brain Injury, 2022
Lucille Xiang, Surbhi Bansal, Albert Y. Wu, Tawna L. Roberts
After the initial screening process, patients must be referred to the appropriate specialists to receive targeted and individualized care. Similar to the lack of standardization for a visual and vestibulo-ocular screening protocol to be used in a primary care setting, a major limitation in treating these patients is that there is no standardized approach to caring for this population and there are no randomized clinical trials to validate current treatment protocols, which may be due to the heterogeneous nature of mTBI. Furthermore, a patient’s functional outcome and treatment duration may likely be affected by which rehabilitation specialist they encounter first. Nonetheless, treatment for visuo-vestibular impairments should incorporate exercises that facilitate the interaction and functional integration between these two systems (10,44). Vestibular therapists, physical therapists, and vision therapists often incorporate exercises that overlap into each subspecialty despite the emphasis of their targeted treatment in their own discipline and only refer the patient to the respective sub-specialty if significant deficits are present or symptoms persist (13). Patients experiencing chronic visual dysfunction in combination with a decline in ocular and overall health after TBI may benefit from both formal vision rehabilitation and vestibular physical therapy (40,45).