Reasons For Delay In Diagnosis Research Articles

Reasons for diagnostic delays in Bipolar Disorder: Systematic review and narrative synthesis

BACKGROUND: Bipolar disorder is common, affecting 1% of people. The diagnosis of bipolar disorder is often delayed, which limits access to effective treatment and increases the burden of disease on individuals, families, and society. AIM: This paper investigates the individual, social, and clinical factors that contribute to delays in diagnosis for people with bipolar disorder, including delays that occur before and after a person presents to a primary care clinician. DESIGN AND SETTING: Systematic review and narrative synthesis. METHOD: Four electronic databases - Embase, Medline, PsychInfo, and Global Health - were systematically searched. This search yielded 3078 studies, 21 of which met the inclusion criteria. The data retrieved were analysed using Braun and Clarke’s Thematic Analysis to report a summary of recent research on the delays in the diagnosis of bipolar disorder. RESULTS: Analysis of the data from the 21 studies identified five main themes as reasons for delays in diagnosis: (1) misdiagnosis, (2) healthcare challenges, (3) mental health stigma, (4) the complex nature of bipolar disorder, and (5) individual factors. CONCLUSIONS: The review demonstrates the importance of educating individuals, families, and clinicians on the symptomology of bipolar disorder to avoid misdiagnosis. Furthermore, changes in the accessibility and delivery of mental health services are essential to ensure that people with bipolar disorder are diagnosed and treated in a timely manner. In addition, mental health stigma among individuals, families, and clinicians must be addressed to reduce diagnostic delays.

Reasons and extent of delay in the diagnosis of pulmonary tuberculosis after the appearance of symptoms

ABSTRACT Objective: Delay in the diagnosis of tuberculosis (TB) is a significant problem at both individual and community levels. Delayed diagnosis of TB contributes to more severe disease manifestations, higher risk of death, and higher disease transmission in the community. We conducted this study to assess the extent and associated reasons for delay in diagnosis of pulmonary TB. Methods: This study was conducted in the Department of TB and Respiratory Diseases, J. N. Medical College, Aligarh, from June 2020 to May 2022. A total of 2053 new pulmonary TB patients, who first consulted any private healthcare provider (HCP) for treatment, were enrolled in the study. The required information was collected by interview technique using a predesigned questionnaire. Results: A total of 2053 patients were enrolled in the study. There was a significant delay of more than 2 weeks in the diagnosis of pulmonary TB after the onset of symptoms in 94% of patients. The extent of delay ranged from 8 days to 240 days with a mean of 36.33 days. The delay in visiting the HCPs by the patient was not significant. Only 5.85% of patients had a significant delay of more than 2 weeks in seeking any health care after the appearance of symptoms. A delay by HCP contributed to a greater portion of the total delay, with a mean of 31.77 days. The main reason for the delay by HCPs was not investigating TB. The hospital delay was not significant. The mean hospital delay was 5.82 days. Conclusion: The delay in the diagnosis of TB in India is very high. A delay by HCPs contributes to a greater portion of the total delay. Information, Education and Communication (IEC) activities will play an important role in reducing the delay. All HCPs should be actively involved in subjecting the suspects to TB diagnosis at the earliest possible as per National Tuberculosis Elimination Programme (NTEP) guidelines.

Reasons for diagnostic delays in Bipolar Disorder: Systematic review and narrative synthesis

BACKGROUND: Bipolar disorder is common, affecting 1% of people. The diagnosis of bipolar disorder is often delayed, which limits access to effective treatment and increases the burden of disease on individuals, families, and society. AIM: This paper investigates the individual, social, and clinical factors that contribute to delays in diagnosis for people with bipolar disorder, including delays that occur before and after a person presents to a primary care clinician. DESIGN AND SETTING: Systematic review and narrative synthesis. METHOD: Four electronic databases - Embase, Medline, PsychInfo, and Global Health - were systematically searched. This search yielded 3078 studies, 21 of which met the inclusion criteria. The data retrieved were analysed using Braun and Clarke’s Thematic Analysis to report a summary of recent research on the delays in the diagnosis of bipolar disorder. RESULTS: Analysis of the data from the 21 studies identified five main themes as reasons for delays in diagnosis: (1) misdiagnosis, (2) healthcare challenges, (3) mental health stigma, (4) the complex nature of bipolar disorder, and (5) individual factors. CONCLUSIONS: The review demonstrates the importance of educating individuals, families, and clinicians on the symptomology of bipolar disorder to avoid misdiagnosis. Furthermore, changes in the accessibility and delivery of mental health services are essential to ensure that people with bipolar disorder are diagnosed and treated in a timely manner. In addition, mental health stigma among individuals, families, and clinicians must be addressed to reduce diagnostic delays.

Delayed Diagnosis of Intracranial Trauma.

Introduction Trauma is one of the leading causes of death and hospitalization in the United States.Head trauma often results in significant morbidity and mortality.This study was undertaken to identify reasons for delay in diagnosis of intracranial trauma. Methods This retrospective study analyzed patients with intracranial trauma between 2016 and 2022, in which there was a delay of two days or more from the date of injury to the date of diagnosis. Results Among 809 patients with head trauma, 140 subjects were identified with delayed diagnosis of intracranial trauma (17.3%).The most common diagnoses were subdural hemorrhage (N = 82; 56%) and intraparenchymal hemorrhage (N = 33; 24%). The most common reasons for delay in diagnosis included patient delay in seeking care (N = 111; 79%), and delayed diagnosis during inpatient hospitalization (N = 16; 11%) (Chi-Square <0.0001) (Table 2). Among inpatients with delayed diagnosis, confounding issues included alcohol intoxication (N = 4; 3%), other injuries (N = 9; 6%), and mental health issues (N = 2; 1%). Conclusions Among patients with delayed diagnosis of intracranial trauma, the majority of delays in diagnosis were due to patient delay in seeking care.Future directions may include improved public education regarding trauma and the importance of seeking timely medical care.

Non Hospital-Acquired Pseudomonas Aeruginosa Keratitis In a Seven Month Old

Pseudomonas aeruginosa is one of the important pathogens causing bacterial keratitis with ulceration. In this study, we evaluated a case of non-hospital-acquired P. aeruginosa keratitis in a 7-month-old infant and its treatment process. The patient who had no known chronic disease was brought in with complaints of watering and redness in the left eye. The complaint of the eye problems started 1 month ago after the patient swam in a farm pool. Keratitis was diagnosed according to an ophthalmologic examination in our clinic. Left corneal scraping cultures were taken for the identification of the pathogen. Moxifloxacin eye drops and ganciclovir gel were prescribed for 10 days. The corneal haze disappeared after the treatment. Reasons for delay in diagnosis and treatment were evaluated in our case. We also compared the keratitis between adults and infants. P. aeruginosa keratitis should be considered in the differential diagnosis, taking into account the presence of resistance to treatment, visual disturbances, lens usage, nasolacrimal duct obstruction, trauma, and bad hygiene. Congenital nasolacrimal duct obstruction is an important risk factor for infants. Vision loss, which may happen in adults, cannot be clearly communicated by infants due to their limited communication abilities. P. aeruginosa should be considered the pathogen causing keratitis in infant patients, particularly when the diagnosed characteristics align with our case.

Economic and Social Burden of Childhood Cancer in Bangladesh.

Cancer is a major cause of morbidity and mortality worldwide. This study aimed to investigate the scale and nature of the socio-economic burdens that face families of children with pediatric cancer in Bangladesh on a day-to-day basis and the reasons for delays in diagnosis and treatment of the disease. A cross-sectional exploratory study including 54 families in Bangladesh who had children with cancer. A structured questionnaire was used to collect quantitative data, supplemented by open-ended questions to gain in-depth information about specific issues. The majority of children were male (n=39, 72.2%) and aged 6-15 (n=38, 70.4%). Blood cancer (n=20, 37%) and acute lymphocytic leukemia (n=25, 46.3%) were the most common diagnoses. Many parents stopped working after their child's cancer diagnosis (n=28, 51.9%). Many families (n=21, 38.90%) spent more per month (e.g., USD 471-1,179) on their child's treatment than their income. No external financial support was available to cover this high expenditure, putting families under financial pressure. Social issues included fear, lack of cancer awareness, stigma in rural communities, low-quality facilities, inappropriate service provider behavior, poor facility hygiene, and high fees. This study revealed that childhood cancer has a substantial impact on parents' socioeconomic status, and many families face financial, social, and psychological challenges. This highlights the need for urgent collaborative action to address these problems.

Primary CNS Lymphoma in an Immunocompetent Patient: An Unusual Case Illustrating the Usual Problems Facing Brain Tumour Management in a Lower-Middle-Income Country

Primary central nervous system lymphoma (PCNSL) is a rare extra-nodal non-Hodgkin lymphoma (NHL). It primarily affects the immunocompromised but is rarely seen in immunocompetent individuals. The pitfalls in the healthcare system of lower-middle-income countries produce many obstacles, impeding timely diagnosis, timely treatment, and optimal quality of care. A 57-year-old immunocompetent, diabetic female presented with progressive generalised fatiguability, forgetfulness, and subtle behavioural changes for the last one and a half years. MRI revealed an area of gyri from dense post-contrast enhancement in the right posterior parietal region. Her symptoms kept aggravating with periods of partial remission as steroids were being administered. Reasons for delays in diagnosis and hence timely treatment include lack of primary care referral, conflicting neurosurgical opinion, and absence of multidisciplinary team management. A right posterior parietal parasagittal craniotomy was performed to excise the lesion. The patient was subsequently referred for adjuvant therapy. We use our patient's clinical journey to exemplify the structural barriers to providing optimal and timely care for brain tumour patients in a developing country. Primary CNS Lymphomas in immunocompetent patients are rare. Poor infrastructure and referral pathways contribute to delayed diagnosis. Lack of multi-disciplinary care owing to organisational issues is a major problem faced by brain tumour patients in a lower-middle-income country like ours. Brain tumour management requires a specialist multidisciplinary team approach to ensure timely diagnosis and optimal treatment

Pyomyositis: case series of 14 patients to study the significance of early diagnosis and management

Introduction Pyomyositis denotes primary pyogenic infection of skeletal muscle. It is predominantly a disease of tropical countries. It usually involves the largest muscle groups around the pelvic girdle and lower extremities. Primary reasons for delay in diagnosis are its low incidence and vague presentation [7]. This delay can result in complications such as extension into and destruction of an adjacent joint, sepsis and, even death. Our study is aimed to highlight the extent and sequence of treatment protocol required for good management of these patients. Methods We retrospectively analyzed our experience with a series of 14 pediatric patients with primary pyomyositis who were treated and followed up. There were five girls and nine boys. All 14 patients underwent plain radiographs, USG and MRI of the affected area followed by surgical drainage and a course of antibiotics. Patients were followed up with weekly CRP. Results Six out of 14 (42.9 %) patients had a history of mild trauma. Ileopsoas muscle was involved in 4 patients, 3 cases in which the gluteals or quadriceps were involved, 2 cases with obturator muscle involvement and 2 cases in which adductors were the infection site. All 14 patients were treated surgically. Conclusion Our study shows that early diagnosis, complete drainage of the purulent material and the use of appropriate antibiotic therapy are the key determinants of successful treatment that lead to complete resolution in the majority of cases.

Study of clinical presentations of lung cancer in tertiary level hospital

Background: Lung cancer is the most common cancer diagnosed worldwide. It is also the leading contributor to cancer-related mortality, resulting in around 1.38 million cancer deaths per year worldwide. The aim and objective of the study was to study the clinical presentations including paraneoplastic manifestations and metastatic effects of lung cancer and to identify reasons for delay in diagnosis of lung cancer.Methods: Hospital based observational study was conducted on 100 consecutive cases.Results: Mean age of the cases with lung cancer was 56.36 years and 30% of the cases. Male predominance was seen with 63% males to 37% females. Tobacco smoking was present in 59% cases while exposure to second hand smoke and biomass fuel was seen in 11% and 9% patients. Most common presenting symptoms were cough (22.21%), chest pain (16.13%), fever (14.37%), dyspnea (11%) and hemoptysis (5.22%). Most common type of lung tumor was Adenocarcinoma (53%) followed by Small cell carcinoma (22%) and Squamous cell carcinoma (19%). Mutation analysis by molecular testing where possible in 76.66% NSCLC cases and showed with RAS (26.19%), EGFR (23.8%), ALK1 (11.9%) and ROS (4.7%) mutation. Stage I and II of lung cancer was seen in 17% cases while stage III and IV was seen in 39% and 44% cases respectively.Conclusions: Present study shown tobacco smoking as the most common risk factor in the causation of lung cancer (59%) followed by passive smoking (11%) and biomass fuel exposure (9%). Mortality in the present study was 72% in 2 years of follow up and Median survival in the study was 11 months. We recommend high index of suspicion in the high-risk groups as smokers and those with chronic respiratory diseases to avoid delay in diagnosis.

An audit on the diagnosis of primary CNS lymphoma

AimsPrimary central nervous system lymphoma (PCNSL) is a rare form of non–Hodgkin lymphoma with exclusive manifestations in the central nervous system, leptomeninges and eyes. It forms around 5% of all primary brain tumours. It is an aggressive tumour which has a poor prognosis if left untreated. It is imperative that diagnosis is made timely so treatment can be started promptly. Therefore, we performed an audit looking into the speed of diagnostic process of PCNSL in our tertiary Neuro–oncology Unit.MethodSingle-centre retrospective review of PCNSL cases referred to a tertiary Neuro–Oncology Unit over a six month period from June to November 2020.ResultsA total of 1309 cases were discussed in the Neuro–oncology MDT meeting over the study period. Fourteen cases (6 male, 8 female; median age [range] 66 [59–83] years) were identified as highly likely PCNSL. Neuroimaging suggested PCNSL as the likely diagnosis in twelve patients. Twelve patients were started on steroids after CT or MRI brain scans. Nine patients had a surgical target and proceeded to have diagnostic brain biopsy. Two patients had different working diagnoses and three patients were deemed unsuitable for brain surgery. One patient required repeat brain biopsy. A tissue diagnosis was made in twelve patients. One patient deteriorated rapidly and one patient had a brain lesion that was deemed too high risk for surgery. The median time between neuroimaging and biopsy was 25 days. The median time taken from first investigation to the pathological confirmation of PCNSL was 36 days (range 6–86 days).ConclusionThe chief reason for delay in diagnosis of PCNSL was that patients were started on steroids before diagnostic investigations were completed. Steroids caused the brain lesions to become smaller or disappear. Accordingly, time was needed to allow withdrawal of steroids before diagnostic investigations could be repeated. Diagnostic delays may have been exacerbated by logistical issues associated with COVID–19. We propose that there needs to be greater awareness of how early introduction of steroids can markedly delay the diagnosis of PCNSL.

Pelvic Avulsion Fractures in Adolescent Athletes: Analyzing the Effect of Delay in Diagnosis.

To evaluate whether delay in the diagnosis of pelvic avulsion fractures in young athletes leads to prolonged treatment and prolonged return toward sport activities, whether fractures at certain locations are associated with a greater risk of diagnostic delay, and what reasons may exist for delay in diagnosis. Retrospective chart review of young patients who presented with pelvic region avulsion fracture to a community-based sports medicine clinic over a 19-year period. Private practice, primary care sports medicine clinic. Patients younger than 20 years diagnosed with pelvic region avulsion fracture. None, this was a retrospective study. Clearance for return toward sport activities. Two hundred twenty-five cases were reviewed for reasons for delay in diagnosis; 208 cases met criteria for the duration of treatment and return to play activities portions of the study. The mean time from date of injury diagnosis was 19.59 days, and the mean duration from date of injury to clearance for return to play advancement was 67.20 days. Duration of treatment varied slightly depending on timing of diagnosis, whereas duration from date of injury to clearance for return to play advancement varied greatly depending on diagnostic delay. Those who did not sense a "pop" at the time of injury were more likely to experience diagnostic delay, as were athletes with ischial tuberosity fractures. The most common cause of diagnostic delay was patient/family decision on when to seek care; misdiagnosis as a muscle strain was also common. Diagnostic delay of adolescent pelvic avulsion fractures may unnecessarily prevent athletes from returning to play within an optimal time frame. Our observations highlight a need for educating athletes and their families on when to seek initial or follow-up medical care as well as educating medical providers regarding the diagnosis of pelvic avulsion fractures.

Beliefs and behaviours of students in health‐related faculties regarding testicular self‐examination

AbstractWhat are the beliefs and behaviours of men students attending health‐related faculties at a university regarding testicular self‐examination? This study was conducted with the aim of identifying the approaches of men students attending health‐related faculties at a university towards testicular self‐examination, determining their levels of awareness of testicular self‐examination and contributing to early diagnosis of testicular tumours. Testicular cancer is a disease that can result in death if not diagnosed early, but high treatment success rates can be achieved if diagnosed early. Lack of knowledge related to the risks created by testicular cancer and to testicular self‐examination, which is very important for early diagnosis in young men, is revealed to be among the reasons for delay in diagnosis and treatment. The study was conducted between September and November 2019 in health‐related faculties of a state university in southern Turkey. The study universe consisted of a total of 370 men students studying in fourth grade in health‐related faculties nursing, medicine and dentistry. A ‘Descriptive Characteristics Form’ and ‘Champion's Health Belief Model Scale’ were used as data collection tools. Percentage, Levene's test, one‐way analysis of variance (ANOVA), chi‐square and eta squared were used to evaluate the data. While 59.6% of students in the nursing faculty stated that they had previously received information related to testicular self‐examination, 72% of students in the medical faculty and 67.7% of students in the dentistry faculty stated that they had not previously received information about this issue. Among students in the nursing faculty who had received information, it was determined that 75.0% had learnt about it in lessons and that 45.9% had performed testicular self‐examination. Regarding the arithmetic means of the sub‐dimension scores of the Champion's Health Belief Model Scale according to faculty attended, there was a significant difference in the benefits (F(2,168) = 4.915; p = 0.08), barriers (F(2,168) = 4.831; p = 0.09) and self‐efficacy/confident (F(2,168) = 5.816; p = 0.04) sub‐dimensions. The study revealed that testicular self‐examination implementation rates and attitudes towards testicular self‐examination among university students studying at health‐related faculties were low.

English

BACKGROUND Abdominal malignancies are a common problem in the western countries and is on a rise in India. This study was conducted to evaluate the reasons for delay in diagnosis and treatment of cancer. METHODS This is a prospective observational study conducted in the Department of Surgery Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, for a period of 2 years with a sample size of 46 patients. RESULTS Delay in presentation was noted in 74% of patients. Among them ‘taking local treatment’ was considered to be the main cause of delay in treatment. There was delay in diagnosis in 8 % of patients. There was delay in initiation of treatment in 18 % of patients. CONCLUSIONS Most of the patients presented in advanced stages to the hospital because of taking local treatment, due to lack of awareness, belief in herbal and ayurvedic treatment, poor financial resources, and fear of surgery. The proper treatment was delayed or denied leading to poor overall outcome. KEY WORDS Delay, Presentation, Diagnosis, Treatment

Delayed diagnoses of Acanthamoeba keratitis at a tertiary care medical centre.

To determine the prevalence and reasons for delays in diagnosis in patients with Acanthamoeba keratitis (AK) presenting to Wilmer Eye Institute, Baltimore, Maryland. This retrospective study analysed all patients with culture-positive AK seen between 2012 and 2019 at a tertiary referral centre. Patient demographic information, clinical history, risk factors, symptom duration, referral patterns, slit lamp examination findings, visual acuity and need for surgery were collected. The study included 45 eyes of 43 patients. On average, patients were symptomatic for 52.6 days before culture collection. Thirty-one percent of patients were diagnosed within 28 days of symptom onset while 69% were diagnosed after 28 days. Before presentation to a tertiary care centre, 69% of patients were evaluated by an ophthalmologist outside of this institution and 27% were evaluated by a provider other than an ophthalmologist. AK was most commonly misdiagnosed as herpetic keratitis, occurring in 38% of patients. The strongest risk factor for AK was contact lens use. Only 11% of patients presented with the classic ring infiltrate and 82% had pain. Patients with an early versus late diagnosis had a mean Snellen visual acuity (VA) of 20/224 versus 20/296 at presentation (p = 0.33) and a mean Snellen VA of 20/91 versus 20/240 at final visit (p = 0.07). 11% of patients required a therapeutic penetrating keratoplasty. Delayed diagnosis of AK in our cohort occurred due to a misdiagnosis as herpetic keratitis, non-specific clinical signs including the lack of pain in a number of patients, and a delay in referral to a tertiary care centre. Any contact lens wearer with an atypical keratitis should be referred promptly for Acanthamoeba cultures.

Patient Journey and Disease-Related Burden in Japanese Patients With Chronic Thromboembolic Pulmonary Hypertension: A Mixed Methods Study

BackgroundUnderstanding patient journey and burden of disease in patients with chronic thromboembolic pulmonary hypertension (CTEPH) helps improve diagnostic and treatment processes. ObjectivesThis study aimed to explore patient journey from time of disease onset to a definitive diagnosis and disease burden in Japanese patients with CTEPH. MethodsA mixed-methods study exploring patient journey and disease burden of 33 Japanese patients with a definitive diagnosis of CTEPH. The patients from 2 university hospitals underwent semistructured interviews. Data were transcribed into verbatim records, and 2 independent researchers conducted thematic analyses. Data concerning patient journey were also analyzed quantitatively with supplementary use of medical records. ResultsMedian times from initial onset of symptoms to a confirmed diagnosis and first visitation to a medical institution to a definitive diagnosis of CTEPH were 32 and 20 months, respectively. Thematic analyses found that, for patients, reasons for delay in seeking initial consultations included misattribution of symptoms to aging or lack of physical strength. For healthcare providers, reasons for delays in diagnosis included poor recognition of CTEPH and difficulty in recalling the disease as a differential diagnosis. Burdens of CTEPH were caused by physical symptoms, and mental and social issues, including restriction of daily activities owing to oxygen therapy, disappointment with the intractable nature of the disease, poor understanding of the disease by other people, and lack of social networks. ConclusionsThis study highlighted physical, mental, and social burdens in patients with CTEPH and possible missed opportunities in making the diagnosis of CTEPH during the patient journey. Increasing disease awareness in healthcare providers and networking among patients may contribute to better patient care.

A systematic review of historical and current trends in Chagas disease.

Introduction:Chagas disease (CD) is caused by Trypanosoma cruzi. When acquired, the disease develops in stages. For diagnosis, laboratory confirmation is required, and an extensive assessment of the patient’s health should be performed. Treatment consists of the administration of trypanocidal drugs, which may cause severe adverse effects. The objective of our systematic review was to analyze data contained in the CD published case reports to understand the challenges that patients and clinicians face worldwide.Materials and methods:We performed a systematic review following the PRISMA guidance. PubMed database was explored using the terms ‘American trypanosomiasis’ or ‘Chagas disease’. Results were limited to human case reports written in English or Spanish. A total of 258 reports (322 patients) were included in the analysis. Metadata was obtained from each article. Following this, it was analyzed to obtain descriptive measures.Results:From the sample, 56.2% were males and 43.8% were females. Most cases were from endemic countries (85.4%). The most common clinical manifestations were fever during the acute stage (70.0%), dyspnea during the chronic stage in its cardiac form (53.7%), and constipation during the chronic stage in its digestive form (73.7%). Most patients were diagnosed in the chronic stage (72.0%). Treatment was administered in 56.2% of cases. The mortality rate for the acute stage cases was 24.4%, while for the chronic stage this was 28.4%.Discussion:CD is a parasitic disease endemic to Latin America, with increasing importance due to human and vector migration. In this review, we report reasons for delays in diagnosis and treatment, and trends in medical practices. Community awareness must be increased to improve CD’s diagnoses; health professionals should be appropriately trained to detect and treat infected individuals. Furthermore, public health policies are needed to increase the availability of screening and diagnostic tools, trypanocidal drugs, and, eventually, vaccines.

S0224 Decreasing the Delays in Clostridioides difficile Infection Diagnosis - A Quality Improvement Initiative

INTRODUCTION: Clostridium difficile is the most common cause of healthcare-associated diarrhea in developed countries. Despite the current rapid C. difficile infection (CDI) testing methods, studies have shown that delays in CDI diagnosis still exist due to various factors. Identification and intervention of modifiable factors contributing to delays could possibly lead to early initiation of appropriate infection control measures and treatment. Our objective is to identify the factors causing the delays at various levels from the time of CDI test order to results. METHODS: We conducted a 6-month retrospective study followed by a 3-month prospective interventional study at Mercy Philadelphia Hospital. Chart review was performed to evaluate the time from CDI test orders to stool specimens collection. Interviews were conducted on CDI patients and a subset of nurses and physicians to identify the reasons for delays in diagnosis. A 3-month intervention was performed to address the delays. This included an Electronic medical record (EMR) alert to notify infection control staff and educating nurses and physicians focusing on the importance of timely CDI testing for initiation of treatment. RESULTS: CDI test orders on 140 patients with 80 in the pre- and 60 post-intervention periods were reviewed. No significant difference in patient characteristics and demographics was noted between the 2 groups. The mean time from the test order to test result was significantly lower after the intervention period compared to the pre-intervention period 2 hours vs. 19 hours (P < 0.0001). CONCLUSION: Factors affecting the time from test order to specimen collection accounted for most of the delays. Education of the health care workers at all levels on prompt isolation of suspected CDI patients and the importance of expedited testing significantly reduced the delays in diagnosis. This may reduce the overuse of empirical CDI therapy, reduce delays in initiation of appropriate therapy and finally, decrease C. difficile transmission with timely isolation.

The Impact of Delays in Low-Income Women's Breast Cancer Experiences.

Low-income, underinsured and uninsured women are less likely to be diagnosed via mammogram and more often diagnosed at later stages, with a resultant negative impact on survival. The New Jersey Cancer Education and Early Detection Program provides access to cancer screening services for low-income, underinsured and uninsured individuals. This program was recently evaluated, and it was found that enrollees were more likely to be diagnosed at later stages than nonenrollees, which may be related to delays in diagnosis and treatment OBJECTIVE: The aim of this study was to determine if there were delays in diagnosis and treatment for program enrollees and, if so, what were the causes of these delays. A qualitative methodology was used incorporating in-depth interviews with 20 women diagnosed with breast cancer through the New Jersey Cancer Education and Early Detection Program. Qualitative content analysis was used for data analysis. Three themes emerged: poor access to healthcare, lack of knowledge, and sense of spirituality. Nineteen of 20 women experienced delays in care; 9 were diagnosed with late stage (III or IV) disease. While the lack of insurance was a factor, fear, family needs, and a tendency to not prioritize their own health were additional reasons for delays in diagnosis and treatment. Programs such as this are integral to the care of low-income, uninsured individuals. However, such programs are not sufficient to meet the needs of low-income women. The lack of a usual source of care is likely to be a factor in the delays these women experienced.

A Summary of the 2020 Gastric Cancer Summit at Stanford University

There exists no coherent national strategy for the early detection or prevention of gastric cancer in the United States (US), even among identified high-risk groups such as Asian Americans, African Americans, Hispanic Americans, and Alaska Native/American Indian peoples. As a result, patients with gastric cancer in the US are diagnosed at later stages and demonstrate worse overall survival compared to nations of East Asia with established screening programs (Table 1). The under-recognition of gastric cancer risk within minority communities is a significant unaddressed healthcare disparity.

Step up approach for the management of late presentation of pancreatic trauma patients

Background: Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities and these injuries are often overlooked in cases with extensive multi-organ trauma. Our study was conducted to evaluate the outcome of a step-up approach in the management of pancreatic trauma patients with late presentation.Methods: The study included 15 patients who presented with grade III AAST delayed presentation of pancreatic trauma from September 2017 to 2019. In our step-up approach 2 staged procedure was done, firstly laparotomy with necrosectomy along with closure of proximal pancreatic duct with external drainage of pancreatic duct, in second stage Roux-en-Y pancreaticojejunostomy was done to drain the remnant pancreas as a definitive procedure 3 to 6 months after initial procedure.Results: In our study, blunt trauma abdomen (83.30%) (n=10) was the most common mode of injury. The main reason for delay in diagnosis of pancreatic trauma was delayed presentation of patient (83.3%) (n=10). Total of 4 patients were admitted to intensive care unit (ICU) at the time of admission. 10 patients underwent both the stages of step up approach management among which one patient had pancreatic fistula as a complication (n=1) (10%) and one patient had post-operative abscess as a complication (n=1) (10%). No mortality was noted in our study.Conclusions: The step-up approach discussed above proves to be beneficial towards management of patients with delayed presentation of pancreatic trauma in our setting.