Interval Assessment Research Articles

PCN327 KEY INTERVALS IN THE PATIENT JOURNEY OF MEN WITH PROSTATE CANCER: EVIDENCE FROM GREECE

Assessment of time intervals in cancer diagnostic pathways constitute a key-input in cancer policy-making. The objective of this analysis was to assess time intervals from prostate cancer symptom recognition until treatment initiation, as well as patients’ perceptions on delays in diagnosis in Greece. A telephone survey, conducted from December 2018 until February 2019 with the use of a structured questionnaire provided the primary data for the analysis. Participants comprised a sample of patients with a diagnosis of localized prostate Ca after 2015, who had completed treatment. Participants were recruited through public and private hospital urology clinics and practices in Attica, Greece. We calculated the time-to-diagnosis (days from detecting an abnormal finding or a bodily change until diagnosis), time-to-treatment (days from diagnosis until treatment initiation) and total interval. 67 patients participated in the survey. For the majority of patients (71.6%) seeking consultation was initiated by a symptom whereas for the 28.4% by an abnormal finding in their screening tests. Median time-to-diagnosis was 60.5 days (mean=163.00, S.D.=356.811), while median time-to-treatment was 30 days (mean=143.51, S.D.=184.851). The median total interval was 91 days (mean=211.40, S.D.=380.160). Concerning participants’ perceptions on delays in diagnosis and treatment, 41.0% replied that they could have received medical care earlier. Of those, 62.5% placed the delay primarily during the patient interval, 29.2% during the diagnosis interval and 8.3% during the treatment interval. The main reasons for those delays (multiple choice) were: not evaluating the symptoms as critical (52.0%), not being consistent with their check-up (32.0%) and physician(s) not understanding the problem (16.0%). Further investigation on the determinants of patient, diagnostic and treatment intervals is essential for the formulation of health policies that aim at early diagnosis and management of prostate cancer in Greece.

Institutional tuberculosis infection control in a rural sub-district in South Africa: A quality improvement study

BackgroundTuberculosis (TB) is a major global health challenge, and South Africa is one of the high-burden countries. A national TB infection control (TBIC) guideline has stipulated three areas of infection control at health facilities: work practice and administrative control, environmental control, and personal protection for health workers.AimThe aim of this study was to identify the gaps and address the challenges in institutional TBIC.SettingThe district hospital and a primary health care clinic within the Mossel Bay sub-district in the Western Cape.MethodsAccording to the national TBIC draft guideline, a quality improvement cycle was used to evaluate and improve TBIC. Each facility had an existing infection and prevention control and occupational health and safety team, which were used as the audit teams.ResultsA baseline assessment was followed by a set of interventions, which did not show a significant improvement in TBIC. The difference between the pre- and post-intervention TB screening rate was not statistically significant. An assessment of time interval between 101 patients presenting with TB symptoms and diagnosed with TB was 4 days at baseline and post-intervention. Most of the anticipated improvements were dependent on the health workers’ adherence to the local TBIC policies, which emerged as an unexpected finding.ConclusionWe found good managerial commitment reflected by the presence of various policies, guidelines, specific personnel and committees to deal with infection control in general. This study has created awareness about TBIC among staff and pointed out the complexity of health workers’ behaviour towards adhering to policies.

Pulsed Doppler Echocardiography: An Historical Perspective

Over the past six decades, echocardiography has evolved into an important technique for not only imaging cardiac structures, but also, by employing the Doppler equation, for assessing cardiac blood flow and tissue velocities. This review focuses on pulsed Doppler echocardiography: its principles, early development, and clinical applications. Important clinical applications include: (1) measurement of flow velocities, stroke volumes, and regurgitant and shunt volumes; (2) assessment of time intervals, e.g., pulmonary artery acceleration time as a measure of pulmonary artery pressure and resistance or the timing of mitral regurgitation in hypertrophic cardiomyopathy; (3) detection of turbulent flow in regurgitation, stenoses, and shunts, enhanced by the implementation of color Doppler; and (4) evaluation of left ventricular diastolic function in conjunction with pulsed tissue Doppler and deformation (strain) measurements.

Prolonged Time Lag to Final Diagnosis of Fragile X Syndrome

To evaluate the diagnostic process in children ultimately diagnosed with fragile X syndrome (FXS), with an emphasis on the time lag between initial presentation and on diagnosis in female vs male children. Interviews were conducted with 89 families of children with a final diagnosis of FXS and assessment of time intervals between initial presentation and confirmed molecular diagnosis. Screening of 117 patients (25 female patients) from the 89 families revealed that less than 20% of patients obtained a diagnosis within the first year of seeking medical attention. Mean age at the time of initial presentation was 12.3 months in male patients and 23 months in female patients, while definitive diagnosis of FXS was made at a mean of 4 and 9 years, respectively. Presenting symptoms of developmental delays were recognized by 72% of parents, and 84% had another child with FXS before the index case diagnosis. Average age of diagnosis for children with FXS born since 2007 was significantly lower at 31.9 months, compared with 69.5 months for children born before 2007. Although FXS is a significant and prevalent cause of disability in children, it is underdiagnosed and diagnosed late, especially in female patients. In every male and female patient presenting with developmental delay or autism, FXS should be considered. Dysmorphic physical features may not be present in infancy, and the absence of those features cannot exclude a diagnosis of FXS.

Assessment of time intervals in the pathway to oral cancer diagnosis in north-westerm Spain. Relative contribution of patient interval.

BackgroundDespite continuous advances in diagnosis and therapy, oral cancers are mostly diagnosed at advanced stages with minor survival improvements in the last two decades. Both phenomena have been attributed to delays in the diagnosis. This study aims at quantifying the time elapsed until definitive diagnosis in these patients and the patient interval’s contribution.Material and MethodsA hospital-based, ambispective, observational study was undertaken on incident cases with a pathological diagnosis of oral squamous cell carcinoma recruited during 2015 at the Oral and Maxillofacial Surgery services of CHUAC (A Coruña) and POVISA (Vigo) hospitals.Results74 consecutive oral cancer patients (59.5% males; median age: 65.0 years (IQ:57-74)) were studied. Most cases (52.7%; n=39) were at advanced stages (TNM III-IV) at diagnosis. The period since first sign/symptom until the patient seeks health care was the longest interval in the pathway to diagnosis and treatment (median: 31.5 days; IQR= 7.0 – 61.0) and represents >60% of the interval since symptom onset until referral to specialised care (pre-referral interval). The average interval assigned to the patient resulted to be relatively larger than the time elapsed since the patient is seen at primary care until a definitive diagnosis is reached (diagnostic interval). Median of the referral interval for primary care professionals: 6.5 days (IQR= 0.0 – 49.2) and accounts for 35% (19% - 51%) of the diagnostic interval.ConclusionsThe patient interval is the main component of the pathway to treatment since the detection of a bodily change until the definitive diagnosis. Therefore, strategies focused on risk groups to shorten this interval should be implemented in order to ease an early diagnosis of symptomatic oral cancer. Key words:Oral cancer, early diagnosis, diagnostic delay, time interval, time to diagnosis, Aarhus statement.

Changes in the Spatial Synchronization of Electrical Potentials in the Neocortex at Different Time Periods between Stimuli on Acquisition of a Set to an Emotionally Negative Facial Expression

Studies in healthy humans (n = 35) were performed using a model of a set to an emotionally negative facial expression with an 8-sec interval between the target (facial image) and trigger signals. Coherence functions for alpha and theta potentials at different parts of the cerebral cortex of the left and right hemispheres were studied at different time intervals during the pre- and post-stimulus periods. The following dynamic was seen: the source of modulation of attention consisted of the internal concept of time intervals between significant stimuli formed in the prefrontal cortex as a result of learning. Analysis of changes in the spatial synchronization of theta potentials at different stages of the set to an “angry” face provided grounds for believing that the corticohippocampal system does not have any direct link with assessment of time intervals, but is associated with the function of emotional memory.

P-1472 - Mental health of women with hysteromyoma

After informed consent we have examined 100 women (18–45 years, mean age was 29,6 ± 3,8 years) with uterine leiomyoma (D 25). Results of examination were processed with Program Kit Statistica (version 8.0). With high level of statistical significance (p Asthenic variant of PDAS was found in 8%, where basic manifestations were feeling of tiredness evenings, muscle pains, apathy, and weakness. Psycho-vegetative variant of PDAS was revealed in 6% of patients and has been represented by paroxysmal vegetative dysfunctions, transient headaches, sleep disorder, feeling of unexplained “melancholy”. Dysthymic variant of PDAS (emotional instability) in the kind of irritability, feeling uneasy and mental discomfort was found in 5%, and dysmnestic variant of PDAS manifesting as short-term changes of attention, orientation in known setting, and wrong assessment of time intervals has been diagnosed in 3%. Mental disturbances corresponded to 4 clusters (ICD-10): neurotic, stress-related and somatoform disorders (F40–48) have been revealed in 29% of women; affective, predominantly of depressive spectrum (F32–34.1) - in 9%; personality disorders and behavioral disorders at mature age (F60–61) - in 3% and behavioral syndromes, associated with physiologic disturbances and physical factors (F50–52) - in 6%. Data demonstrates high prevalence of mental disturbances in female patients that decreases adaptive abilities, worsens severity of state and quality of life and efficacy of therapy.

Cancer of the oro- and hypopharynx – when to expect recurrences?

Conclusion. Relapse-free survival (RFS) of patients suffering from cancers located in the oro- and hypopharynx (COH) is strongly related to the localization and initial tumor stage; 25% of relapses remain undetected by the patients themselves. To detect relapse at an early stage oncologic follow-up should be performed at close intervals during the first 3 years. For confirmation imaging procedures should be indicated generously as well as control endoscopy under general anesthesia. Objectives. COH are often characterized by a rapid progression of disease in case of relapse. Most of these relapses are already incurable at the time of diagnosis. The aim of the present study was the assessment of time intervals between initial diagnosis of the primary tumor and its relapse. Patients and methods. The course of disease of 280 patients was analyzed. RFS was evaluated statistically. Results. RFS was strongly related to the location of the primary tumor. The median RFS of patients suffering from oropharyngeal cancer was longer (86 months) than that of patients with hypopharyngeal carcinomas (45 months). Patients with COH revealed an accumulation of recurrent disease within the first 33 months after initial diagnosis. Within the first 2 years more than 60% of COH recurred. After 3 years 80% had developed a relapse.