Evaluation of the joint orthodontic-paediatric-restorative clinic at Leeds Dental Institute: a review of referral sources, case management, and outcomes.

A Multidisciplinary Bone Metastases Clinic at Toronto Sunnybrook Regional Cancer Centre — a Review of the Experience from 1999 to 2005

Our objective in this study was to review the experience of a one-stop multidisciplinary bone metastases clinic (BMC) that offers a coordinated multidisciplinary approach to the care of cancer patients with bone metastases in a tertiary cancer centre. Patients with symptomatic bone metastases were referred to BMC and assessed by a team of specialists in various disciplines – interventional radiology, orthopedic surgery, palliative medicine, and radiation oncology. At initial consultation, patient demographics, reasons for referral, and case disposition were recorded. From January 1999 to February 2005, a total of 272 patients with bone metastases were referred to the BMC. The median age was 65 years (range 28–95) and median KPS score at consultation was 60 (range 30–90). The majority of patients came from home (74%), while others came from a nursing home or the hospital (9%). Almost a third (28%) of patients had 2 or more reasons of referral, yielding a total of 354 reasons. The most common reason for referral was bone pain (42%), bone metastases (21%), high risk for pathological fracture (12%), and pathological fracture (10%). Of the 272 patients who received consultation, 40% received palliative radiotherapy, 19% received interventional surgery, 7% were referred to other support services such as palliative care, physiotherapy, and 7% had further investigation or imaging. A multidisciplinary clinic is useful for co-coordinating the management of bone metastatic disease in symptomatic patients.

The aim of this study was to investigate the subsequent dental treatment needs of children who had dental extractions under general anaesthesia (GA) in 1997 in the Day Case Unit at Leeds Dental Institute (LDI), Leeds, UK, and the reasons for repeat dental GAs (DGAs). The authors conducted a retrospective longitudinal analysis. Information collected from hospital records for the 6-year period following the first DGA included: reasons for the DGA in 1997 and teeth extracted; the number of subsequent DGAs, reasons and treatment; incidents of and reasons for toothache or swelling after 1997; treatment under local anaesthesia (LA) or inhalation sedation (IS) at LDI during the 6 years following the DGA in 1997. The study population consisted of 484 children, who received GA exodontia at LDI with a mean age of 6.35 years [95% confidence interval (CI) = 6.1, 6.6] and age range of 1-16 years. The most common reason for extractions at the original DGA in 1997 was dental caries, and the mean number of extractions was 4.24 (95% CI = 4.05, 4.43). Primary teeth extractions accounted for 82% of the cases. In total, 143 children (27.5%) had a record of follow-up treatment at LDI. Of these children, 32% had treatment under LA, 7% under LA and IS, and 15% received preventive care only. The overall repeat rate for DGA was 10.7%, with caries (84%) being the main reason for this. Of the teeth subsequently extracted, 72% were recorded as caries-free or unerupted at the time of the DGA in 1997. A large proportion of the follow-up visits were to treat newly developed dental disease during the 6 years following the DGA in 1997. A more proactive approach towards preventive care may have resulted in the reduction of the development of new dental disease.

Thank you very much for inviting me to give the Talmage Read Lecture, on the occasion of the centenary of the founding of the Leeds Dental School and Hospital. Professor Read obviously had a major impact on the Leeds Dental School. (Fig. 1)

There is a dearth of studies which are related to consultation-liaison psychiatry in India. The psychiatric referral rates in India are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a hospital. Studying the pattern of psychiatric referrals may pave the way for interventions to improve the current scenario. The study population comprised of all the patients who were referred for psychiatric consultation from other departments (both in-patient and out-patient) of the hospital over a period of two years. Data which was related to socio-demographic profile, source of referral, reason for referral and the psychiatric diagnosis were recorded and analyzed by using descriptive statistical methods. A total of 520 patients were referred for psychiatric consultation, with a referral rate of 0.42%. A majority of the psychiatric referrals (59%) were from the department of medicine and the most common reason for referral was medically unexplained somatic complaints (23.1%), followed closely by anxiety (21%) and abnormal behaviour (13.1%). The most commonly diagnosed psychiatric disorders were neurotic, stress related and somatoform disorders (41.7%) followed by mood disorders (12.9%) and substance use disorders (12.7%). There is a need to encourage multi-disciplinary interaction in the management of patients who attend general hospitals, so as to better identify the psychiatric morbidity. Further studies should focus on interventions that can improve referral rates through early recognition of the common psychiatric conditions, with particular emphasis on sensitizing the general physicians, who are the most common source of psychiatric referrals.

Inherited renal disorders comprise a significant proportion of cases in both paediatric and adult nephrology services. Genetic advances have advanced rapidly while clinical models of care delivery have remained static. To describe a cohort of patients attending a multidisciplinary renal genetics clinic and the insights gained from this experience. A retrospective review of clinic cases and their molecular genetic diagnosis over a 5-year period. We report details of 244 individuals including 80 probands who attended the clinic. The commonest reasons for referral was familial haematuria which accounted for 37.5% of cases and cystic kidney disease, accounting for 31% of cases. Eighteen probands had a known molecular genetic diagnosis and were referred for genetic counselling and screening of at risk relatives and management plans. About 62 probands and their families were referred for a precise molecular diagnosis and this was achieved in 26 cases (42%). The most frequent new genetic diagnoses were COL4A5 mutations underlying familial haematuria and familial end stage renal disease. The clinic also allowed for patients with rare renal syndromes to be reviewed, such as ciliopathy syndromes, allowing detailed phenotyping and often a precise molecular genetic diagnosis to be provided. The integration of modern day genetics and genomics into multidisciplinary clinics often allows a precise diagnosis which benefits patients, their relatives and the clinicians providing care and future management.

Who makes the call? Examining the relationship between child maltreatment referral sources and case outcomes in the United States, 2008-2018

Understanding referral patterns to chaplains is essential not only to ensure proper patient treatment, but also to assist chaplains seeking to expand the range of patient situations in which they are called to intervene. Information about more than 58,000 chaplain visits was documented during the first two years (2005-2006) of the Metropolitan Chaplaincy Study. Data from 15,655 of these visits, which were made in response to referrals (26.9% of all visits), were analyzed in the present study. Seventy-eight percent of referral requests were met within the same day, and 94.9% of requests and were met within 2 days. Nurses were the most frequent source of referrals to chaplains (45.0%), followed by self-referrals from patients or requests from their family members (30.3%), with the remainder coming from a variety of hospital disciplines. The most common reason for referrals was that patients requested to see a chaplain. Other relatively common reasons for referrals were problems or issues related to illness or treatment, and end-of-life issues, concerns about death and the death of patients, with reasons for referrals differing by referral source. The most common reason for referrals among professional staff was that patients were feeling bad or in pain, followed by medical issues, and end-of-life issues. Patient and family referrals usually involved positive patient affect, whereas staff referrals usually involved negative patient affect.

61 Background: Queen’s Medical Center (QMC) was selected as one of 14 sites nationwide to participate in the expansion of the National Cancer Institute’s Community Cancer Centers program in 2010. In 2011, QMC implemented Multidisciplinary Clinics (MDC) to make the treatment of patients with head and neck (H&N), thyroid, thoracic, and GYN malignancies more efficient and seamless. The purpose of this study was to examine the following process outcomes: timeliness of care, adherence to MDC treatment plans and national guidelines, and utilization of ancillary services in H&N, thyroid, thoracic, and GYN MDC. Methods: Retrospective, chart review of patients with H&N, thyroid, thoracic, and GYN malignancies who were seen at the MDC from Jan 2012 to Dec 2012 was conducted. Variables collected were patient demographics, initial date of referral to the MDC, date of first cancer treatment, clinical variables (e.g. cancer diagnosis, co-morbidities, social habits [smoking, drinking, drug use]), and hospital process variables (e.g. reasons for delay in treatment, adherence to national guidelines, and use of ancillary services [e.g. navigation, dietary, survivorship, social work, chaplain, genetic counseling]). Results: 222 charts were reviewed (H&N = 69, Thyroid = 54, Thoracic = 48, Gyn = 51). Ethnic minorities represented over 50% of the sample. For all cancers combined, average time to referral to first treatment was 32 days. Post-hoc analysis showed that patients seen in GYN MDC (mean = 17.5 + 12.3 days) had significantly fewer days from referral to first cancer treatment compared to patients seen in the H&N MDC (mean = 41.3 + 25.6 days), F = 4.3, p = 0.003. For all sites combined, there was 99.5% adherence to the MDC recommended treatment plans, and 100% adherence to NCCN guidelines in the treatment received. Most patients with GYN malignancy (96.1%) were referred to one or more ancillary services followed by H&N (88.4%), thoracic (85.4%), and thyroid (46.3%). Conclusions: Study provided baseline process outcomes for MDC of disease sites which are often less studied in literature. MDC nurse coordinator played a critical role in ensuring efficient and quality patient care. Results can serve as basis for further quality improvement.

Since the early 1980s, policymakers and analysts have urged hospitals to be more active in managing the care of their patients beyond the hospital walls. In particular, hospitals have been criticized for failing to address the postdischarge needs of elderly patients with chronic health problems. An influential essay in The New England Journal of Medicine observed that “most of these institutions have no comprehensive geriatric program geared to the long-term medical, rehabilitative, and social needs that are linked to acute illness. To provide quality care, hospitals must make a commitment to long-term care for the chronically ill elderly patient. It is becoming apparent that no one else can.” As part of a strategy for addressing this perceived shortcoming, the authors argued, “Unlike other providers, hospitals could offer comprehensive case management of patients, from home care to acute care, thus ensuring continuity of services.” Under this approach, hospital-based case managers would identify clients, assess their needs, develop care plans, coordinate service delivery, and monitor results. Since many of these activities would take place after the patient left the hospital, hospital-based case management would be a considerable extension of hospitals’ typical discharge planning activities. In part, it was expected that the costs of hospital-based case management programs would be covered through user fees. If the hospital also offered long-term care services, hospital-based case management could generate additional revenues through increased use of these services. If it facilitated the earlier discharge of Medicare patients and reduced Medi-

BackgroundCongenital heart disease (CHD) is the most common form of congenital anomalyand is a leading cause of neonatal morbidity and mortality. Major congenital heart disease (CHD) is defined as any...

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006

International Journal of Dental HygieneVolume 4, Issue s1 p. 3-10 Dental diseases – are these examples of ecological catastrophes? PD Marsh, PD Marsh PD Marsh, Health Protection Agency, Centre for Emergency Preparedness and Response, Porton Down, Salisbury, UK, and Leeds Dental Institute, Leeds, UKSearch for more papers by this author PD Marsh, PD Marsh PD Marsh, Health Protection Agency, Centre for Emergency Preparedness and Response, Porton Down, Salisbury, UK, and Leeds Dental Institute, Leeds, UKSearch for more papers by this author First published: 01 September 2006 https://doi.org/10.1111/j.1601-5037.2006.00195.xCitations: 37 PD Marsh Health Protection AgencyCentre for Emergency Preparedness and ResponsePorton DownSalisburySP4 0JGUKTel.: 44 (0)1980 612287 (direct)Fax: 44 (0)1980 612622E-mail: phil.marsh@hpa.org.uk Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume4, Issues1September 2006Pages 3-10 RelatedInformation

International Journal of Paediatric DentistryVolume 20, Issue s1 p. 5-5 British Society of Paediatric Dentistry: a policy document on management of caries in the primary dentition T. KANDIAH, T. KANDIAH 1Paediatric Dentistry, Eastman Dental Hospital, London, UKSearch for more papers by this authorJ. JOHNSON, J. JOHNSON Paediatric Dentistry, St Georges Healthcare NHS Trust, London, UKSearch for more papers by this authorS. A. FAYLE, S. A. FAYLE Paediatric Dentistry, Leeds Dental Institute, London, UKSearch for more papers by this author T. KANDIAH, T. KANDIAH 1Paediatric Dentistry, Eastman Dental Hospital, London, UKSearch for more papers by this authorJ. JOHNSON, J. JOHNSON Paediatric Dentistry, St Georges Healthcare NHS Trust, London, UKSearch for more papers by this authorS. A. FAYLE, S. A. FAYLE Paediatric Dentistry, Leeds Dental Institute, London, UKSearch for more papers by this author First published: 18 August 2010 https://doi.org/10.1111/j.1365-263X.2010.01087.xCitations: 17Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume20, Issues1Special Issue: Supplement for the 2010 Annual Scientific Meeting of the British Society of Paediatric Dentistry, Sheffield, UK, 16‐17 September 2010November 2010Pages 5-5 RelatedInformation

GerodontologyVolume 19, Issue 1 p. 5-16 Erosive toothwear in the elderly population Heather A Pontefract, Corresponding Author Heather A Pontefract Restorative Division, Leeds Dental Institute, Clarendon Way, leeds I S2 pLUDr Heather A Pontefract Restorative Division Leeds Dental Institute Clarendon Way Leeds LS2 9LU. Tel: +H44 (0)113 343 6191. Fax: +44(0)113 343 6179. e-mail: H.A.Pontefraet@leeds.ac.ukSearch for more papers by this author Heather A Pontefract, Corresponding Author Heather A Pontefract Restorative Division, Leeds Dental Institute, Clarendon Way, leeds I S2 pLUDr Heather A Pontefract Restorative Division Leeds Dental Institute Clarendon Way Leeds LS2 9LU. Tel: +H44 (0)113 343 6191. Fax: +44(0)113 343 6179. e-mail: H.A.Pontefraet@leeds.ac.ukSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1111/j.1741-2358.2002.00005.xCitations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume19, Issue1July 2002Pages 5-16 RelatedInformation