Patient-related Delay Research Articles

Severe odontogenic infections in patients with mental disorders—the challenge of ineffective initial treatment

ObjectivesThis study clarified possible delays and deficiencies in severe odontogenic infection (OI) treatment in patients with mental disorders. Study DesignData of hospitalized patients with severe OI were evaluated retrospectively. The outcome variable was preceding health care visits prior to hospitalization. The primary predictor was patient's mental disorder. Explanatory variables were age, sex, smoking, heavy alcohol use, immunocompromised disease or medication, and time span from beginning of symptoms to hospitalization. Also, factors leading to intensive care unit (ICU) care were evaluated. ResultsPreceding visits prior to hospitalization were found in 61 (35.5%) out of 172 patients with OI. In total, 27 patients (15.7%) had a current mental disorder, more commonly in women (26.0%) than in men (8.1%) (P=0.001). Patients with mental disorders had preceding health care visits related to the current infection notably more often than patients without recent psychiatric history (51.9% vs. 32.4%), P=0.053). Patient-related treatment delay remained non-significant. Heavy alcohol use (P=0.010) and smoking (P=0.025) predicted ICU treatment, but no association with patient's mental disorder was found. ConclusionsA patient's mental disorder can complicate diagnosis of OI. Effective and timely treatment requires the professional's ability to simultaneously identify the patient's mental health challenges and progressing OI.

Abstract WP64: Assessment of a Smartphone App-Sensor to Assist Patients in Identification of Neurologic and Cardiac Emergencies: The Emergency Call for Heart Attack and Stroke (ECHAS) Study

Introduction: While timely therapy of neurologic and cardiac emergencies can improve outcomes, patients often fail to identify acute events resulting in delays in seeking emergency care. ECHAS is a smartphone application and sensor system aimed to reduce patient-related delay. We performed a retrospective study to test ECHAS in identifying patients who required emergency assessment for possible myocardial infarction (MI) or stroke. Methods: We enrolled 202 patients (57 with stroke-like, 145 MI-like symptoms) who presented to the ED at a single center in Canada. Participants answered yes-no questions about their prior history, acute symptoms, and performed a finger-tapping test on an Apple iPhone with ECHAS. Answers resulted in a risk score that guided one of the three triage decisions: 1) call 911, 2) call hotline, or 3) call your primary care physician. The ground truth for the triage decision assessment was the appropriateness of the patient’s visit to the ED. Specificity could not be calculated due to low numbers of patients who did not need emergency evaluation. Results: The mean time to complete the acute assessment was 60 seconds for MI and 111 seconds for stroke. ECHAS output recommended 66% of patients call 911, 30% hotline, and 4% primary care follow-up. The sensitivity to identify the need for emergency evaluation was 0.98. The sensitivity to identify patients who were admitted for possible MI or stroke was 1.0. A negative correlation was found between low ECHAS score and prolonged symptom onset to hospital arrival time for MI-like symptoms (r = -0.21, p < 0.05). Patients found ECHAS to be very useable (Fig 1). Conclusion: The ECHAS application was highly sensitive and easily usable in guiding patients to identify medical emergencies without input by healthcare personnel. These pilot results will drive a planned 4,000-patient prospective randomized trial to evaluate whether ECHAS will reduce times from symptom onset to first medical contact for MI and stroke.

Diagnostic odyssey of Guillain-Barré syndrome in children

Background and ObjectivesA gap exists between difficulty in diagnosis and importance of early recognition and intervention in pediatric Guillain-Barré syndrome (GBS). Therefore, this study aimed to establish a diagnostic odyssey plot that allows “at-a-glance” overview of the diagnostic odyssey of GBS in children, including overall diagnostic delay, physician-related and patient-related diagnostic delays, and length and frequency of diagnostic errors. MethodsIn this single-center retrospective cohort study, standardized data were obtained from children with GBS from 2003 to 2020. Overall diagnostic delay (time between symptom onset and diagnosis), physician-related diagnostic delay (time between the first medical visit and diagnosis), and patient-related diagnostic delay (time between symptom onset and the first medical visit) were analyzed. ResultsThe study examined a total of 21 patients (11 men, median age 4.5 years). Overall, there were 40 misdiagnoses among 17 patients, while four were diagnosed correctly at the first visit. The overall diagnostic delay was 9 days [interquartile range (IQR), 6–17 days]. Physician-related diagnostic delay, but not patient-related diagnostic delay, was correlated with the overall diagnostic delay. Patients in the late-diagnosed group were more frequently misdiagnosed during their diagnostic odyssey than patients in the other groups. Risk factors associated with diagnostic delay included delayed onset of weakness and sensory deficits, absence of swallowing problems, and misdiagnosis as orthopedic disorders or viral infections. DiscussionA unique diagnostic odyssey exists in pedaitric GBS. Several clinical risk factors were associated with the diagnostic delay.

Is the Risk of Thyroid Storm Higher When Patient-Related Factors Delay Treatment of Hyperthyroidism, Or Is It Higher When Patients Undergo Thyroidectomy While Still Thyrotoxic?

ThyroidVol. 33, No. 6 CommentariesIs the Risk of Thyroid Storm Higher When Patient-Related Factors Delay Treatment of Hyperthyroidism, Or Is It Higher When Patients Undergo Thyroidectomy While Still Thyrotoxic?Douglas S. RossDouglas S. RossAddress correspondence to: Douglas S. Ross, MD, Massachusetts General Hospital, WAC-730 S, Boston, MA 02114, USA E-mail Address: dross@mgh.harvard.eduDivision of Endocrinology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.Search for more papers by this authorPublished Online:8 Jun 2023https://doi.org/10.1089/thy.2023.0086AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Is the Risk of Thyroid Storm Higher When Patient-Related Factors Delay Treatment of Hyperthyroidism, Or Is It Higher When Patients Undergo Thyroidectomy While Still Thyrotoxic?." Thyroid, 33(6), pp. 664–665FiguresReferencesRelatedDetails Volume 33Issue 6Jun 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Douglas S. Ross.Is the Risk of Thyroid Storm Higher When Patient-Related Factors Delay Treatment of Hyperthyroidism, Or Is It Higher When Patients Undergo Thyroidectomy While Still Thyrotoxic?.Thyroid.Jun 2023.664-665.http://doi.org/10.1089/thy.2023.0086Published in Volume: 33 Issue 6: June 8, 2023Online Ahead of Print:May 30, 2023PDF download

Colonoscopy surveillance in Lynch syndrome is burdensome and frequently delayed.

Individuals with Lynch syndrome have an increased colorectal cancer risk, hence, biennial colonoscopy surveillance is recommended. We aimed to investigate patients' perception and preferences regarding surveillance, and to further explore compliance behaviour. Individuals with Lynch syndrome received a validated survey evaluating experiences of their three most recent colonoscopies. Individuals were non-compliant to surveillance if the interval between colonoscopies differed ≥ 6months from the recommended interval. In total, 197 of 291 (68%) invited individuals returned the survey. They mostly underwent colonoscopy biennially (99%), under mild sedation (79%) and with bowel preparation performed by Moviprep® (99%). Surveillance was perceived as impacting quality of life in 21%, and as moderately to extremely burdensome in 57%, particularly in those below age 40. To lower the burden, patients prioritised improvements in volume and taste of bowel preparation, laxation-related bowel movements, waiting times, and a more personal and respectful approach of endoscopic staff. Additionally, many individuals (60%) would favour less-invasive surveillance modalities such as biomarkers. In total, 28% of individuals had delayed colonoscopy surveillance, predominantly for patient-related reasons. An additional 10% considered quitting/postponing surveillance. Upon multivariable analysis, patient-related delay was associated with low and medium education, history of ≤ 4 colonoscopies and having no hospital recall-system. Colonoscopy surveillance in Lynch syndrome is often experienced as burdensome, and frequently delayed. We identified determinants of surveillance behaviour in this population, and present potential interventions to reduce the burden and non-compliance rates.

P209 Delayed IBD diagnosis increases risk of requiring biologics in first 4-years - an Inception cohort study

Abstract Background Delays in diagnosis can be due to patient and health-system related factors. The impact of such delays in Inflammatory Bowel Diseases (IBD), particularly on biological therapies, continues to be of interest. The aim of the study was to investigate if delays could predict need for biologics and report on related adverse outcomes (AOs). Methods New patients referred for suspected IBD to a single tertiary care centre between Jan 2013 to Dec 2017 were identified using EMR. For this study, delay-types and cut-off times for each type were set based on best average hospital waiting times. The reasons for delays until start of treatment were recorded; data on the start of biologics, duration, and reasons for switch (if required) were recorded. Data was analysed using multiple Pearson correlations and Cox proportional Hazard model to determine whether any delay-types could predict need for biologics and compare the risk between patients with or without delay. Results 105 patients were identified using stringent criteria (M=58; median age=32y) with a median follow-up of 55 months. 65, 27 and 13 patients had a final diagnosis of Ulcerative colitis, Crohn’s disease, and Unclassified colitis respectively, and were analysed collectively. A model that combined delay in seeking medical attention, and time taken from specialty review to index endoscopy exhibited the best predictive power with average AUROC of 0.67. When individual delay-types were analysed, it was noted that most delay-types increased the risk of biologic use: a) delay in seeking medical attention [OR-1.08(1.03 1.17)] b) delay from GP referral to specialty review [OR-1.10(1.0 1.23)] c) delay from specialty review to index endoscopy [OR-1.09(1.01 1.21)] On further analysis, there was a statistically significant increase noted in the risk of requiring biologics at any time during the follow-up period. Fig 1A illustrates survival without biologics when there is a delay of >2 weeks in seeking medical attention (p=0.042). Figure 1B illustrates survival without biologics when there is delay of >6 weeks from GP referral to index endoscopy (p=0.021). Figure 1A- Patient-related delay of >2weeks and risk of needing biologics (p=0.042) Figure 1B- Health-system related delay of >6weeks and risk of needing biologics (p=0.021) Conclusion The risk of requiring biologic therapy is higher in those patients who have faced any type of delay in their diagnosis of IBD. A patient-related delay of >2weeks and cumulative health-system related delay of >6weeks increase the risk of requiring biologic therapy at any time during their follow-up. Both primary and secondary care must work to reduce any delays as this has long-term implications for patients and economic implications for health care providers.

The Impact of the COVID-19 Pandemic on Breast Cancer Patients.

The coronavirus disease-2019 (COVID-19) pandemic causes delays in the diagnosis and treatment of cancer patients due to fear of contagion and lockdown. This study aims to investigate the effects of the COVID-19 pandemic on breast cancer patients treated in our breast center. Patients who applied to our clinic with the diagnosis of invasive breast cancer in March 2020 and March 2021 (Study Group) when the COVID-19 pandemic was observed, and in March 2019 and March 2020 before the COVID-19 pandemic (Control Group) were compared in terms of demographic, clinical and pathological characteristics. Statistical analyses were performed using the SPSS software version 21. There were 176 (46%) patients in the study and 206 (54%) patients in the control group. Almost a 15% reduction was detected in patients admitted during the COVID-19 pandemic. The rate of pre-menopausal patients and patient-related delay time (PRDT) were significantly higher in SG (57.7% vs. %45, p=0.013, 2.58 vs. 1.82-month, p=0.001, respectively). There was a larger tumor size and more metastatic lymph nodes after NAC in the SG, but the differences were not significant. There was no difference regarding breast cancer stages and molecular subtypes between the two groups, but there was significantly more de novo stage IV breast cancer in the SG (p=0.009). The incidence of neo-adjuvant chemotherapy and type of surgical therapy was similar between the two groups. COVID-19 pandemic caused a decrease in the number of patients who applied to our clinic and increased patient-related delay time due to fear of transmission and lockdown. The rate of de novo stage IV breast cancer was also significantly increased.

EARLY SUCCESS AND COST-EFFECTIVENESS OF A SOCIAL MEDIA CAMPAIGN TO REDUCE PRE-HOSPITAL DELAYS IN PATIENTS WITH POSSIBLE ACUTE CORONARY SYNDROME

Despite many improvements in percutaneous coronary intervention (PCI) and hospital systems of care, prehospital delay remains a significant barrier to timely reperfusion in acute coronary syndromes (ACS). Prolonged delays to reperfusion results in poor patient outcomes. There is data to support the efficacy of educational interventions to reduce patient-related prehospital delay in the setting of possible ACS, especially in chest pain patients. Traditional media such as television and radio are highly dependent on a ratings system: that is, how many people in an audience can be reached.

Factors that influence diagnostic delay among pulmonary tuberculosis patients in Osogbo, Nigeria

Objectives: Delay in the diagnosis of pulmonary tuberculosis (TB) is reportedly common in Nigeria. This results in delayed initiation of treatment and increased spread of the disease. This study assessed diagnostic delay and its influencing factors among pulmonary TB patients who were attending directly observed treatment clinics in Osogbo, Nigeria. Materials and Methods: This descriptive cross-sectional study was carried out from August to October 2019 in 10 directly observed treatment clinics in Olorunda Local Government Area, Osogbo, Osun State, Nigeria. Multistage random sampling was used to select 280 registered TB patients. Data were collected using an interviewer-administered semi-structured questionnaire and analyzed with Statistical Package for the Social Sciences version 23. Results: Most respondents, that is, 220 (80.3%) were Yoruba, 69 (25.2%) had tertiary education, and 53 (19.3%) had no education at all. Only 135 (49.3%) respondents had good knowledge of pulmonary TB. We found that 157 (57.3%) respondents had patient-related diagnostic delays, while 135 (49.3%) had health system-related delays. Median patient-related delay was 1 month, while median health system-related delay was 3 weeks. There was no significant association between patient-related delay and any sociodemographic characteristic, knowledge about TB, or perceived attitude of health care workers. A significant difference in health-system-related delay was found concerning the attitude of health care workers toward patients (P = 0.043) and patients’ religion (P = 0.030), and level of education (P = 0.001). Conclusion: While pulmonary TB is common in the lower socioeconomic class, health workers should be open-minded while evaluating all patients to ensure correct and prompt diagnosis. A good attitude of health workers towards patients is important for preventing diagnostic delays.

Global burden of the COVID-19 associated patient-related delay in emergency healthcare: a panel of systematic review and meta-analyses.

BackgroundApart from infecting a large number of people around the world and causing the death of many people, the COVID-19 pandemic seems to have changed the healthcare processes of other diseases by changing the allocation of health resources and changing people’s access or intention to healthcare systems.ObjectiveTo compare the incidence of endpoints marking delayed healthcare seeking in medical emergencies, before and during the pandemic.MethodsBased on a PICO model, medical emergency conditions that need timely intervention was selected to be evaluated as separate panels. In a systematic literature review, PubMed was quarried for each panel for studies comparing the incidence of various medical emergencies before and during the COVID-19 pandemic. Markers of failure/disruption of treatment due to delayed referral were included in the meta-analysis for each panel.ResultThere was a statistically significant increased pooled median time of symptom onset to admission of the acute coronary syndrome (ACS) patients; an increased rate of vasospasm of aneurismal subarachnoid hemorrhage; and perforation rate in acute appendicitis; diabetic ketoacidosis presentation rate among Type 1 Diabetes Mellitus patients; and rate of orchiectomy among testicular torsion patients in comparison of pre-COVID-19 with COVID-19 cohorts; while there were no significant changes in the event rate of ruptured ectopic pregnancy and median time of symptom onset to admission in the cerebrovascular accident (CVA) patients.ConclusionsCOVID-19 has largely disrupted the referral of patients for emergency medical care and patient-related delayed care should be addressed as a major health threat.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12992-022-00836-2.

Average time taken by a Rheumatology patient to reach a Rheumatologist in Pakistan.

To study the time taken by individuals from onset of symptoms related to rheumatic diseases to approaching a rheumatologist, and to establish the various delaying factors. The cross-sectional study was conducted at the Department of Medicine, Division of Rheumatology, Combined Military Hospital, Lahore, Pakistan, from August 1 to December 31, 2020, and comprised patients of either gender diagnosed with inflammatory arthritis or other connective tissue diseases. Demographic and clinical data, including antibody status, was recorded. Time lag in visiting a rheumatologist at different levels and factors causing the delay were identified. Data was analysed using SPSS 22. Of the 235 patients, 186(79%) were females and 49(21%) were males. The overall median age was 39 years (interquartile range: 29-50 years.). Of the total, 52(22%) patients presented in <12 weeks of symptom onset to a rheumatologist. Median time for patient-related delay was 6 months (interquartile range: 1-12 months), while the median time for physician-related delay was 8 months (interquartile range: 2-42 months). The median time for appointment delay was 1 week (interquartile range: 1-2 weeks). Median duration from the start of symptoms to evaluation by a rheumatologist was 24 months (interquartile range: 6-72 months). The most common delaying factor 131(55.7%) was lack of proper assessment at the primary care level. No association was found between age and time of presentation (p>0.05), but male gender, higher socioeconomic status, higher education level and rheumatoid factor negativity presented earlier compared to the rest (p<0.05 each). The primary care physician's delayed referral was found to be the most important factor resulting in delayed presentation to a rheumatologist.

Delayed Tuberculosis Treatment and Cost of Care in a Low-Incidence Country.

BackgroundTuberculosis (TB) elimination requires high-quality, timely care. In countries with a low incidence of TB, such as Ireland, delayed diagnosis is common. This evaluation aimed to determine the factors that predict patient-related and health care provider–related delays in TB management and to establish how TB care cost is affected by care delays.MethodsHealth care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1, 2018, and December 31, 2019, were reviewed to measure and determine predictors of patient-related delays, health care provider–related delays, and the cost of TB care. Outcomes were compared against benchmarks derived from the literature.ResultsThirty-seven patients were diagnosed with TB, and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider–related delay among patients with PTB was 16 days and, although similar to the benchmark (median, 22 days; minimum, 11 days; maximum, 36 days), could be improved. The health care provider–related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298 and, while similar to that reported in the literature (median, €9319; minimum, €6486; maximum, €14 750), could be improved. Patient-related delays among those with PTB predicted care costs.ConclusionsPatient-related and health care provider–related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.

Study of Diagnostic Delay among Symptomatic Breast Cancer Patients in Northern India: A Mixed-Methods Analysis from a Dedicated Breast Cancer Centre

Objective:We conducted this study to understand the factors that contribute to the delay in diagnosis of symptomatic breast cancer patients. Methodology:We did a prospective analytical study with both quantitative and qualitative components over 14 months. The total delay in diagnosis of breast cancer from first symptom onset was defined as diagnostic delay. Presentation delay was defined as the time duration between the first symptom and the first visit to a health care provider. Provider delay was defined as the time duration between the presentation to a health care provider and the final diagnosis. Three hundred female breast cancer patients with a diagnostic delay of at least 3 months were interviewed using a pre-tested semi-structured questionnaire. Results:We found that more than 50% of patients with delayed presentation were between 30-50 years of age. Painless breast lump was the most common initial symptom. More than 70% of patients presented with locally advanced and metastatic disease. The patient-related delay was more common than provider delay. Breast cancer awareness (p = 0.040) and reasons for delay (p = 0.014) were found to significantly influence the delay. More than 70% of patients reported their symptoms to male members of their families. Conclusion:Breast cancer awareness is the single most important determinant influencing diagnostic delay among symptomatic patients.

Correlates of Delayed Initial Contact to Emergency Services among Patients with Suspected ST-Elevation Myocardial Infarction

Background Early diagnosis and treatment of a patient displaying symptoms of myocardial ischemia is paramount in preventing detrimental tissue damage, arrhythmias, and death. Patient-related hospital delay is the greatest considerable cause of total delay in treatment for acute myocardial infarction. Objective To identify patient characteristics contributing to prehospital delay and ultimately developing health interventions to prevent future delay and improve health outcomes. Methods A retrospective chart review of 287 patients diagnosed with ST-elevation myocardial infarction (STEMI) was evaluated to examine correlates of patient-related delays to care. Results Stepwise logistic regression modeling with forward selection (likelihood ratio) was performed to identify predictors of first medical contact (FMC) within 120 minutes of symptom onset and door-to-balloon (DTB) time within 90 minutes. Distance from the hospital, being unmarried, self-medicating, disability, and hemodynamic stability emerged as variables that were found to be predictive of FMC within the first 120 minutes after symptom onset. Similarly, patient characteristics of gender and disability and having an initial nondiagnostic electrocardiogram emerged as significant predictors of DTB within 90 minutes. Conclusions Individual attention to high-risk patients and public education campaigns using printed materials, public lectures, and entertainment mediums are likely needed to disseminate information to improve prevention strategies. Future research should focus on identifying the strengths of prehospital predictors and finding other variables that can be established as forecasters of delay. Interventions to enhance survival in acute STEMI should continue as to provide substantial advances in overall health outcomes.

Tuberculosis national registries and data on diagnosis delay – Is there room for improvement?

Introduction and objectivesExcessive delay in the diagnosis of Tuberculosis may have a negative impact on the epidemiological control and elimination of this disease. An accurate determination and analysis of delay times may help identify where and how to improve Tuberculosis diagnosis according to local needs. The Portuguese Tuberculosis Surveillance System – SVIG-TB – is the main source of data regarding diagnosis delay. However, to our knowledge, there has been no recent evaluation of its data. This study's primary aim was to conduct a thorough quantitative and qualitative evaluation of data obtained from the SVIG-TB registry concerning the delay in Tuberculosis diagnosis in Matosinhos, a Portuguese municipality. MethodsAll patients living in the Matosinhos municipality diagnosed with Tuberculosis between January 1st 2012 and December 31st 2019 were identified and individual SVIG-TB records retrieved. Patient-related, Healthcare-related and Total delay in Tuberculosis diagnosis were determined based on data obtained from this source and compared to data recovered from patient record review. Missing data, registering errors and differences in diagnosis delay between these two sources were analysed and compared. Subsequently, diagnosis delay data from a recent Portuguese nationwide SVIG-TB paper, covering years 2010 to 2014, was compared to local SVIG-TB and patient record review data. ResultsThis study identified a significantly greater percentage of cases with missing data on delay in SVIG-TB records when compared to Patient Record Review (57.2% versus 1.11%). The median patient-related, healthcare-related and Total delay in Tuberculosis diagnosis were of 17, 30 and 68 days, respectively, in the SVIG-TB based data. A significant underestimation of healthcare-related and total Tuberculosis diagnosis delay was identified in SVIG-TB data when compared to Patient Record Review. There was no significant difference between Patient-related delays determined from these two sources. Compared to the national study results, missing values were more common in this data set (57.2 vs 44.6%), mainly due to the absence of patient-related delay data. Median Total and Healthcare-related delays were significantly greater in Matosinhos Municipality, regardless of the data source (SVIG-TB or Patient Record Review). The patient-related delay was, conversely, shorter. ConclusionsSVIG-TB has been crucial in guiding National Public Health policies on the path towards Tuberculosis elimination in Portugal. However, there is still room for improvement. These results provide a basis for further reflection on the shortcomings and potential of SVIG-TB in guiding the national Tuberculosis program.

Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry.

In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.

Diagnostic Delay of Pulmonary Embolism in COVID-19 Patients.

Pulmonary embolism (PE) is a frequent, life-threatening COVID-19 complication, whose diagnosis can be challenging because of its non-specific symptoms. There are no studies assessing the impact of diagnostic delay on COVID-19 related PE. The aim of our exploratory study was to assess the diagnostic delay of PE in COVID-19 patients, and to identify potential associations between patient- or physician-related variables and the delay. This is a single-center observational retrospective study that included 29 consecutive COVID-19 patients admitted to the San Matteo Hospital Foundation between February and May 2020, with a diagnosis of PE, and a control population of 23 non-COVID-19 patients admitted at our hospital during the same time lapse in 2019. We calculated the patient-related delay (i.e., the time between the onset of the symptoms and the first medical examination), and the physician-related delay (i.e., the time between the first medical examination and the diagnosis of PE). The overall diagnostic delay significantly correlated with the physician-related delay (p < 0.0001), with the tendency to a worse outcome in long physician-related diagnostic delay (p = 0.04). The delay was related to the presence of fever, respiratory symptoms and high levels of lactate dehydrogenase. It is important to rule out PE as soon as possible, in order to start the right therapy, to improve patient's outcome and to shorten the hospitalization.

Hospital admissions for acute coronary syndrome during the first wave of COVID-19 pandemic in Israel: a single tertiary center experience

Hospital admissions for acute coronary syndrome during the first wave of COVID-19 pandemic in Israel: a single tertiary center experience

Utilization of government healthcare services by adult leprosy patients in the Western Province, Sri Lanka.

The leprosy services utilization by the patients at the clinic and field level should be high to achieve the target of eliminating leprosy as a public health problem in Sri Lanka. Furthermore, assessing patient and health system delay of a diagnosis and patient knowledge on disease are of equal importance to reveal the accurate picture. A descriptive cross-sectional study was conducted to assess the utilization of government healthcare services by 672 adult leprosy patients in Western Province (WP). Paucibacillary patients diagnosed at least six months and above, and Multibacillary patients diagnosed at least 12 months and above were selected by consecutive sampling method. An interviewer-administered questionnaire (IAQ) was used for data collection. Clinic utilization by leprosy patients was 87.8%. The mean patient-related delay (time taken from the onset of symptoms to the encounter of a doctor/health facility for the first time) was 16.8 months and health care system delay (time taken from the date of clinic registration to start of treatment) was 21.2 days. The overall delay was 17.5 months. Services provided by the Medical Officer of Health (MOH) office for families affected with leprosy was known by 53.8% (n = 298) of patients. Majority of family contacts were examined at the hospitals (n = 299, 44%), 30.8% (n = 207) by the Public Health Inspectors (PHI) and 7% (n = 46) at the MOH offices. PHIs had visited 56.7% (n = 401) of the patient's houses and 54% (n = 363) had received health education by PHI. Mean knowledge score was 50.7 (SD = 17.9). More than half (57.9%, n = 389) of the study sample had a good or very good knowledge level. Utilization of clinic services was satisfactory. However, a considerable patient-related delay was found. Half of the patients were aware of available field services and a majority of contact screening was conducted at hospitals. Patient knowledge on leprosy was satisfactory.

PTERJİUM CERRAHİSİ İÇİN NEDEN BEKLENİR?

AMAÇ: Pterjium cerrahisi yapılan hastalarda ameliyat zamanını etkileyen faktörleri bulmak ve alınabilecek önlemleri tespit etmek amaçlanmıştır.GEREÇ VE YÖNTEM: Ocak 2014-Şubat 2017 arası kliniğimizde pterjium nedeniyle cerrahi yapılan 53 hastanın 53 gözü çalışmaya alındı. Hastaların bilgileri, ameliyatı bekleme sebepleri ve cerrahi öyküsü sorgulandı. Hastaların cevaplarına göre gruplandırma yapıldı: Hastalığını bildiği halde çok fazla rahatsızlık duymamak (grup 1), hastalığının farkında olmamak (grup 2), ameliyat olmak için pterjiumun biraz daha ilerlemesini beklemek (grup 3), pterjium cerrahisi daha önce geçirip yine tekrarlamasından endişe etmek (grup 4) ve ameliyattan korkmak (grup 5).BULGULAR: En çok karşılaşılan pterjium ameliyatı geciktirme nedeni; hastalığını bildiği halde çok fazla rahatsızlık duymamak idi. İkinci sırada ise, ameliyat olmaktan korkmak olduğu tespit edildi. Cerrahiyi geciktirme nedenleri dağılımı şu şekilde idi: 1.Grup 23 (%43.4), 2.grup 8 (%15.09), 3.grup 8 (%15.09), 4.grup 4 (%7.55), 5.grup 10 (%18.87) hasta.SONUÇ: Pterjiumda hasta kaynaklı ameliyat zamanı gecikmesinin ameliyat başarısını ve sonuçlarını etkileyebileceği, yapılacak ameliyatla ilgili hastaların bilgilendirilmesi, hastaların endişelerinin giderilmesinde psikolojik-sosyal destek verilmesi ameliyat olma zamanında gecikmeleri önleyebilir.