Referral Protocols Research Articles

Abstract WP324: Integrated Systems Enhance Equitable and High-Quality Stroke Prevention Clinic Care

Stroke prevention clinics were established in Ontario to provide comprehensive, equitable, evidence-based care for patients at high risk of stroke. However, depending on where patients present with their stroke symptoms there are differences in access to diagnostic services. Patients presenting to a primary care office or small hospital, have limited or no access to diagnostic services compared to those presenting to large academic hospitals. To overcome this inequitable access to stroke expertise and diagnostics, we developed a standard referral protocol, a centralized approach to triage and dedicated diagnostic imaging services in regional stroke prevention clinics. The objective of our research was to evaluate the degree to which these system supports have resulted in comprehensive stroke prevention best practice care. Retrospective data analysis was completed using the FY 2011/12 Ontario Stroke Audit of Secondary Stroke Prevention Clinics database. We examined differences in secondary stroke prevention best practices across the five stroke prevention clinics and if there were differences in practice by referral source (Emergency vs. Primary Care). A total of 1853 patients were seen at the five Champlain stroke prevention clinics in 2011/12. The majority of referrals were initiated from Emergency Departments 58.7%, followed by primary care 29.2%, specialists 9.2% and inpatient units 2.8%. Overall, high rates of neuroimaging (97.6%), and vascular imaging (97.6 %) were achieved with little variation across stroke prevention clinics. There was no variation in imaging rates by referral source. The stroke prevention clinics facilitated neuroimaging and vascular imaging for almost 30% of patients, as they did not have these tests completed at the site of initial presentation. Implementing a centralized stroke prevention clinic referral and triage system has enabled equitable access to essential diagnostic testing in the Champlain region. Rapid diagnostic imaging plays a vital role of in identifying stroke etiology, and influences patient prioritization, treatments and management in the stroke prevention clinic setting. Future research should include evaluation of patient outcomes relative to the timing of diagnostic testing.

The Second Set of ‘C’s

You have accessThe ASHA LeaderFirst Person on the Last Page1 Feb 2016The Second Set of ‘C’sA retired SLP reflects on three principles that she learned were critical to treating clients of all ages. Carol KauffmanMA, CCC-SLP Carol Kauffman Google Scholar More articles by this author , MA, CCC-SLP https://doi.org/10.1044/leader.FPLP.21022016.72 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In On March 26, 2014, I hung up my speech-language pathologist’s hat after almost 40 years. What have I learned that may be useful to other SLPs? Three fundamental principles stand head-and-shoulders above any specific treatment from my arsenal. I have affectionately dubbed these principles my “second set of ‘C’s,” earned only after decades of in-the-trenches experience. Collaborate Research has confirmed that everything is connected—from gut to brain to behavior. I was determined to learn all I could from those in the fields of mental health, occupational therapy, physical health and education. We met for coffee at Starbucks. I attended their seminars, studied their research. Together, we devised red-flag screenings, setting up reciprocal referral protocols. Conversely, those in other professions seemed very appreciative when I shared tips from my own areas of expertise. No one profession had the answer, but we each had discovered little answers that—when integrated into more comprehensive treatment plans—often further enhanced our clients’ outcomes. Commiserate Commiserate?! Yep. As a parent of a child with challenges, I know well the heartache one feels as her child struggles—in school, at home, in life. Studies have shown that validation is one of the most powerful techniques in our communication arsenal. When we validate, we help others feel they are not alone, that others care and that they truly matter. Human beings have a fundamental need to feel heard. When I learned to truly listen, commiserate and validate my clients’ frustrations—from cranky toddlers to irate parents to adults with dementia—the change in their demeanor and subsequent eagerness to work with me was nothing short of miraculous. Celebrate In one of our sessions, Keith, a 14-year-old with severe neurodevelopmental disabilities, identified a functional word—a first for him. We whooped and high-fived right there on the spot. A year later, when I left the clinic, his mom wrote: “I will always remember the day we celebrated Keith’s reading milestone. I can’t thank you enough for caring so much about his successes.” A moment of celebration turned the day into a special memory lasting a lifetime for this family. Mother Teresa once said, “You don’t have to do great things; just small things with great love.” I learned over the years that no technique was worth more than my efforts to communicate heart-to-heart with my families, rejoicing in every step forward, no matter how small. In the last three decades of the 20th century, I witnessed remarkable advances in the treatment of people with communication disorders. The 21st century is even more promising for astounding improvements in our treatments and technologies. But I am convinced that authentic human connection is—and always will be—the essential foundation. Author Notes Carol Kauffman, MA, CCC-SLP, owned Language Learning Consultants in Columbus, Ohio, providing contractual services to clinics, hospitals, home health, schools and early intervention programs. She also led seminars for Premier Education Solutions, Inc., in Eau Claire, Wisconsin. Now retired, she plans to keep her “C”s (all six of them) in her new role as grandmother to 1-year-old Camden. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 21Issue 2February 2016 Get Permissions Add to your Mendeley library History Published in print: Feb 1, 2016 Metrics Current downloads: 301 Topicsleader_do_tagasha-article-typesleader-topicsCopyright & Permissions© 2016 American Speech-Language-Hearing AssociationLoading ...

Linkage and Referral to HIV and Other Medical and Social Services: A Focused Literature Review for Sexually Transmitted Disease Prevention and Control Programs.

Sexually transmitted disease (STD) program and clinic staff play an important role in providing linkage and referrals to programs and services that address the complex medical and psychosocial needs of their clients. We synthesized recent published literature related to effective practices for linkage to care for HIV and referral to other medical and social services. Three PubMed searches were conducted to identify relevant studies published since 2004 on (1) linkage to HIV care, (2) referral within STD clinical contexts, and (3) (review articles only) referral practices among all medical specialties. Systematic review procedures were not used. Thirty-three studies were included in this review. Studies highlight the limited value of passive referral practices and the increased effectiveness of active referral and linkage practices. Numerous studies on linkage to HIV care suggest that case management approaches, cultural-linguistic concordance between linkage staff and clients, and structural features such as colocation facilitate timely linkage to care. Integration of other medical and social services such as family planning and alcohol screening services into STD settings may be optimal but resource-intensive. Active referral practices such as having a written referral protocols and agreements, using information technology to help transfer information between providers, and making appointments for clients may offer some benefit. Few studies included information on program costs associated with linkage and referral. Recent literature provides some guideposts for STD program and clinical staff to use in determining their approach to helping link and refer clients to needed care. Much experience with these issues within STD services remains unpublished, and key gaps in the literature remain.

Common injuries in field hockey

Field hockey is considered as a popular sport worldwide next to soccer in popularity. According to National Collegiate Athlete Association overall injury rate is 6.3%/1000 athlete exposure. Mechanism of injury could be extrinsic injury that is, being struck by hockey stick or ball or intrinsic injury due to internal force acting on muscle or an overuse injury which includes tibial stress syndrome, shin soreness, illiotibial band pain, low back dysfunction, tendonitis, patello-femoral pain, planter fasciitis, and stress fracture of foot and leg. Initial approach to injured athlete includes airways, breathing, circulation, rest, ice, compression, elevation, referral protocol, normalize joint range of motion (ROM), restore strengthening, Improve proprioception, agility and balance, minimize chance of re injury by maintaining flexibility. Strengthening and therapeutic exercises that will vary accordingly to the injured part. Countermeasures include preparticipation screening, preseason conditioning, fitness program, adequate warm and pregame stretch, followed by cool down and postgame stretch, following rules and penalty and finally by wearing protective equipment. This article discusses the biomechanics and common injuries in field hockey. Patho-mechanics, diagnosis, and physiotherapy management of the common injures are outlined. This may help the health care practitioners who deals with different injuries related to hockey.

How is inflammatory bowel disease managed in Spanish gastroenterology departments? The results of the GESTIONA-EII survey

Not all national health centers include specialized units or clinicians devoted to inflammatory bowel disease. The goal of the survey was to gain an insight into the management of this disease within Spanish gastroenterology departments via a survey among their members. An online survey was conducted in February and March 2015, among SEPD members (2017 clinician members), who were split into three categories: heads of department, general gastroenterologists, and experts in this disease. The results of the last two surveys are reported, including demography-related questions and specific questions on the strategies and resources available for the care of these patients. A total of 166 responses were received (response rate 8.19%), excluding those from heads of department (previously published). Sixty gastroenterologists considered themselves experts in inflammatory bowel disease, and 106 non-experts in it, the latter being either general gastroenterologists or specialists in other areas, mainly endoscopy. Twenty-eight percent of non-expert gastroenterologists said their hospitals had specific units, with a monographic clinic in 46%. However, 26% reported that they were treating affected patients themselves. Experts in inflammatory bowel disease reported that their institute had resources to support their work, but there was a lack of surgeons with expertise in this condition, particularly in county hospitals. At least, within SEPD members, 2 out of 3 experts in inflammatory bowel disease seem to have the resources available for their work (nurses, day unit, telephone line, database, referrals, joint sessions). Although there is room for improvement (email to contact patients, devoted surgeon, absence of referral protocols), and 2 out of 3 are concerned about pharmacy costs. Since a substantial number of patients remain treated by general practitioners, rapid referral programs might be helpful in this setting.

Adult exceptional aesthetic referral protocol and its implications on the consent for Orthognathic surgery

Adult exceptional aesthetic referral protocol and its implications on the consent for Orthognathic surgery

Harms from discharge to primary care: mixed methods analysis of incident reports.

BackgroundDischarge from hospital presents significant risks to patient safety, with up to one in five patients experiencing adverse events within 3 weeks of leaving hospital.AimTo describe the frequency and types of patient safety incidents associated with discharge from secondary to primary care, and commonly described contributory factors to identify recommendations for practice.Design and settingA mixed methods analysis of 598 patient safety incident reports in England and Wales related to ‘Discharge’ from the National Reporting and Learning System.MethodDetailed data coding (with 20% double-coding), data summaries generated using descriptive statistical analysis, and thematic analysis of special-case sample of reports. Incident type, contributory factors, type, and level of harm were described, informing recommendations for future practice.ResultsA total of 598 eligible reports were analysed. The four main themes were: errors in discharge communication (n = 151; 54% causing harm); errors in referrals to community care (n = 136; 73% causing harm); errors in medication (n = 97; 87% causing harm); and lack of provision of care adjuncts such as dressings (n = 62; 94% causing harm). Common contributory factors were staff factors (not following referral protocols); and organisational factors (lack of clear guidelines or inefficient processes). Improvement opportunities include developing and testing electronic discharge methods with agreed minimum information requirements and unified referrals systems to community care providers; and promoting a safety culture with ‘safe discharge’ checklists, discharge coordinators, and family involvement.ConclusionSignificant harm was evident due to deficits in the discharge process. Interventions in this area need to be evaluated and learning shared widely.

Incidence of Idiopathic Normal-Pressure Hydrocephalus in Northern Spain

Although the incidence of idiopathic normal-pressure hydrocephalus (iNPH) can be 1.20 cases/1000 inhabitants/year in individuals ≥ 70 years old, in most series, the incidence of shunt-responsive iNPH appears to be <1/100,000 inhabitants/year. We report the results of a prospective 10-year longitudinal study of the incidence of iNPH in a northern Spanish population. In a stable population of 590,000 inhabitants served by a single neurosurgical department, we periodically asked all primary care practitioners, neurologists, and geriatricians to refer for iNPH screening any patient with ventricular dilation who was complaining of motor disturbances, cognitive impairment, or sphincter dysfunction. From January 2003 to December 2012, 293 patients were referred with suspected normal-pressure hydrocephalus. In 187 patients, iNPH was diagnosed; 89 of these patients were classified as probable iNPH, and 98 were classified as possible iNPH. Cerebrospinal fluid diversion was performed in 152 patients, and 119 showed a good outcome. The incidence of iNPH was significantly greater in male patients and patients >60 years old and increased exponentially with age. After age 60, the standardized age- and sex-adjusted incidence rates for iNPH, shunt surgery for iNPH, and shunt-responsive iNPH were 13.36 cases/100,000 inhabitants/year, 10.85 cases/100,000 inhabitants/year, and 8.55 cases/100,000 inhabitants/year. No differences were detected in the response rate between probable and possible iNPH (80.52% vs. 76.00%; P = 0.497). Even with a protocol for patient referral in place, reported iNPH incidence was lower than predicted, reflecting a persistent problem of underdiagnosis in our population.

Changes in referral protocols for cardiac surgery: Do financial considerations come at a cost?

Introduction and objectivesThe aim of this study was to determine whether changes to referral protocols for cardiac surgery have had an impact on waiting times, hospitalizations and mortality during the waiting period and during the first year of follow-up after surgery. MethodsIn this retrospective study of patients referred for cardiac surgery between January 1, 2008 and September 30, 2014, the study population was divided into two groups: those referred before (group A, January 1, 2008 to August 31, 2011) and after (group B, September 1, 2011 to September 30, 2014) the change in referral protocols. A telephone follow-up was conducted. ResultsThere were 864 patients referred for cardiac surgery, 557 in group A and 307 in group B. Patient characteristics were similar between groups. The mean waiting time for surgery was 10.6±18.5 days and 55.7±79.9 days in groups A and B, respectively (p=0.00).During the waiting period two patients (0.4%) were hospitalized in group A and 28 (9.1%) in group B (p=0:00); mortality was, respectively, 0% and 2.3% (p=0.00). During one-year follow-up 12.8% of group A patients and 16% of group B patients were hospitalized. Cardiovascular mortality in this period was around 5% in both groups (p>0.05). ConclusionChanges to referral protocols for cardiac surgery had an impact on waiting times, on the number of hospitalizations and on mortality in this period.

Alteração nas redes de referenciação de doentes para cirurgia cardiotorácica: as razões económicas serão destituídas de custos?

Introduction and ObjectivesThe aim of this study was to determine whether changes to referral protocols for cardiac surgery have had an impact on waiting times, hospitalizations and mortality during the waiting period and during the first year of follow‐up after surgery. MethodsIn this retrospective study of patients referred for cardiac surgery between January 1, 2008 and September 30, 2014, the study population was divided into two groups: those referred before (group A, January 1, 2008 to August 31, 2011) and after (group B, September 1, 2011 to September 30, 2014) the change in referral protocols. A telephone follow‐up was conducted. ResultsThere were 864 patients referred for cardiac surgery, 557 in group A and 307 in group B. Patient characteristics were similar between groups. The mean waiting time for surgery was 10.6±18.5 days and 55.7±79.9 days in groups A and B, respectively (p=0.00).During the waiting period two patients (0.4%) were hospitalized in group A and 28 (9.1%) in group B (p=0:00); mortality was, respectively, 0% and 2.3% (p=0.00). During one‐year follow‐up 12.8% of group A patients and 16% of group B patients were hospitalized. Cardiovascular mortality in this period was around 5% in both groups (p>0.05). ConclusionChanges to referral protocols for cardiac surgery had an impact on waiting times, on the number of hospitalizations and on mortality in this period.

Brought in Dead: An Avoidable Delay in Maternal Deaths.

Maternal brought in dead are the patient who dies in the need of adequate medical care. These deaths are often not analyzed sincerely as they are not institutional deaths. Our aim is to find out actual life threatening cause of delay leading to death. Patients brought dead to casualty were seen by the doctors on duty in Department of Obstetrics and Gynaecology,Gandhi Medical College, Bhopal round the clock. Cause of death was analyzed by verbal autopsy of attendants and referral letter from the institute. In this analytical study a complete evaluation of brought deaths from January 2011 to Decmeber 2014 was done. A total of 64 brought in deaths were reported in this 4year duration. Most common cause of death was postpartum hemorrhage (54.68%) followed by hypertension (15.62%) and the most common cause of delay was delay in getting adequate treatment (56.25%). The brought in dead are the indicator of the three delays in getting health care. Challenges appear to be enormous to be tackled. Timely management proves to be critical in preventing maternal death. Thus it appears that community education about pregnancy and its complications, EmOC training at FRU and strict adherence to referral protocol may help us to reduce the brought dead burden.

Identification and Referral of Patients at Risk for Post-traumatic Stress Disorder: A Literature Review and Retrospective Analysis

Post-traumatic stress disorder (PTSD) is a well-established psychological disorder after severe traumatic injury but remains poorly recognized. Recent changes in the "Resources for Optimal Care of the Injured Trauma Patient 2014" stress the need for comprehensive screening and referral for PTSD and depression after injury. Our purpose was to review the current PTSD literature and perform a retrospective chart review to evaluate screening at our institution. We hypothesized a lack of documentation and thus referral of these patients to mental health professionals. We performed a literature review of 43 publications of risk factors for PTSD in the civilian adult population followed by a retrospective review. Records were analyzed for basic demographics, risk factors found in the literature, and referrals to mental health providers. Risk factors included amputation, dissociative symptoms, female gender, history of mental health disorder, and peri-traumatic emotionality. Traumatic amputation status and gender were recorded in all patients. History of mental health disorder was present in 11.5 per cent patients, absent in 80.75 per cent, and not recorded in 7.75 per cent with an overall documentation of 91.75 per cent. Dissociative symptoms and peri-traumatic emotionality were recorded in 0.5 per cent and 1.0 per cent of patients, respectively. Only 13 patients of 400 (3.25%) were referred to mental health professionals. Despite extensive evidence and literature supporting risk factors for the development of PTSD, identification and treatment at our level 1 trauma center is lacking. There is a need for consistent screening among trauma centers to identify PTSD risk factors and protocols for risk reduction and referrals for patients at risk.

SUN-PP066: Nutritional Adequacy in Enterally-Fed Critically III Patients: An Evaluation of Dietitian Blanket Referral Protocol

SUN-PP066: Nutritional Adequacy in Enterally-Fed Critically III Patients: An Evaluation of Dietitian Blanket Referral Protocol

SUN-PP068: Gastroschisis and Its Challenges to Neonatologist: Multiple Adaptive Systems

Methods: This prospective cohort study included 94 patients on mechanical ventilation and stayed in ICU for 72 h. APACHE II score, SOFA score, prescribed and delivered nutrition during first 7 days ICU admission, and time of EN initiation were collected. Patients were classified using Nutrition Risk In the Critically ill (NUTRIC) score. Outcome variables included mechanical ventilation days, ICU length of stay and mortality. Linear and logistic regressions were used to determine differences in outcomes using SPSS software. Results: EN was initiated 24±28 h of ICU admission and 89% of patients met the guideline of EN initiation within 48 h of admission. Patients received an average of 814±434 kcal and 39±22 g protein per day, corresponding to 52±26% and 53±29% of energy and protein prescription respectively. Feed interruption throughout ICU stay was 47±34 h per patient. The top two common reasons were fasting for intubation or extubation, and high gastric residual volume, which contributed to 26% (12±4 h) and 16% (7±18 h) of total interruptions per patient, respectively. In patients with high NUTRIC score (n = 74), there were no differences in the outcome variables when adjusted for age, gender, APACHE II score, SOFA score and energy-protein adequacy in the first 7 days of ICU admission. Conclusion: A dietitian blanket referral protocol can ensure early EN initiation. This alone is insufficient to achieve adequacy of EN delivered. Feed interruption plays a significant role in affecting nutritional adequacy and should be addressed in the feeding protocol.

SUN-PP067: Caloric and Protein Intake in Critically III Patients and Outcome

Methods: This prospective cohort study included 94 patients on mechanical ventilation and stayed in ICU for 72 h. APACHE II score, SOFA score, prescribed and delivered nutrition during first 7 days ICU admission, and time of EN initiation were collected. Patients were classified using Nutrition Risk In the Critically ill (NUTRIC) score. Outcome variables included mechanical ventilation days, ICU length of stay and mortality. Linear and logistic regressions were used to determine differences in outcomes using SPSS software. Results: EN was initiated 24±28 h of ICU admission and 89% of patients met the guideline of EN initiation within 48 h of admission. Patients received an average of 814±434 kcal and 39±22 g protein per day, corresponding to 52±26% and 53±29% of energy and protein prescription respectively. Feed interruption throughout ICU stay was 47±34 h per patient. The top two common reasons were fasting for intubation or extubation, and high gastric residual volume, which contributed to 26% (12±4 h) and 16% (7±18 h) of total interruptions per patient, respectively. In patients with high NUTRIC score (n = 74), there were no differences in the outcome variables when adjusted for age, gender, APACHE II score, SOFA score and energy-protein adequacy in the first 7 days of ICU admission. Conclusion: A dietitian blanket referral protocol can ensure early EN initiation. This alone is insufficient to achieve adequacy of EN delivered. Feed interruption plays a significant role in affecting nutritional adequacy and should be addressed in the feeding protocol.

PWE-018 Trends in endoscopic stenting and clinical outcome for oesophageal malignancy over the last decade in north east scotland

<h3>Introduction</h3> Management of dysphagia due to oesophageal cancer can be challenging and self-expanding metal stents (SEMS) have an important role in this. SEMS have been placed under direct vision in our institution since 2004 and a previous audit showed a significant rise in numbers particularly repeat stenting. A new referral protocol was implemented from 2011 to better aid assessment and appropriate insertion of SEMS and so the aim of this study was to assess changes in trends of SEMS insertion following this. <h3>Method</h3> Retrospective analysis of all oesophageal SEMS inserted in our institution from 2004 to 2014 was performed. Patient demographics, tumour pathology and location, repeat stenting and 30 day mortality were recorded. Emerging trends were analysed by examining changes on a yearly basis and proportional analysis before and after the change in referral protocol. <h3>Results</h3> 393 patients with a mean age 72.9 years (242 males) were included with 510 SEMS being inserted overall (117 repeat stents) and Figure 1shows this graphically. Median age was 77 in 2004 which dropped steadily over the decade to 71 in 2010 and then remained between 73–75. SEMS insertion increased significantly from 6 in 2004 to 74 in 2011 and then dropped to 52 over the next 3 years. Repeat stenting rose until 2012 (1 in 2004 to 18 in 2011) and then fell following the change in protocol. The majority of tumours were adenocarcinomas (&gt;60%) and were in the distal oesophagus or gastro-oesophageal junction. 30 day mortality peaked in 2010 and then steadily declined following the change in protocol but has increased again in the last year. <h3>Conclusion</h3> There has been a significant increase in the number of SEMS inserted in our institution over the last decade. The previous audit revealed that patients were likely being stented too soon and the change in protocol has reduced overall numbers but more importantly repeated stenting. The recent rise in mortality may represent SEMS being inserted closer to the end of a patients life and therefore a true palliative intervention. <h3>Disclosure of interest</h3> None Declared.

Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus.

Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation.Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex consultations at general practitioner practices. Qualitative data were collected through interviews with general practitioners and medical specialists, focus groups and notes from meetings in the Netherlands between April 2013 and January 2014. Data were analysed using a conventional content analysis which resulted in categorised barriers, facilitators and policy adjustments, after which preconditions were formulated.Results: The most important preconditions were make arrangements on governmental level, arrange a collective integrated IT-system, determine the appropriate profile for medical specialists, design a referral protocol for eligible patients, arrange deliberation possibilities for general practitioners and medical specialists and formulate a diagnostic protocol.Conclusions: The barriers, facilitators and formulated preconditions provided relevant input to change the design of substituting hospital care with primary care.

Understanding and Application of Current Concussion Guidelines by Emergency Department Physicians

PURPOSE: Currently, 1.6-3.8 million concussions occur each year, with 1.2-1.3 million individuals seen in the Emergency Department (ED). Less than 25% of Emergency Physicians at a level 1 trauma center used recognized guidelines when treating sports related concussions (Gieble, Kothari, Koestner, Mohney & Baker, 2011). The proposed project was designed to (a) identify the current concussion guidelines utilized at various levels of ED and (b) examine the confidence individual ED physicians have in various current guidelines. METHODS: A survey was developed to examine the current level of understanding and confidence among Emergency Physicians. This assessment included diagnosis, treatment, return to activity and referral protocols. Demographics questions included level of training, years in emergency medicine, hospital classification, and number of concussions diagnosed recently. There were several outcomes in this study including (a) assess current baseline knowledge of ED Physicians in various settings, and (b) statistically compare the knowledge levels. RESULTS: The content analysis revealed that physicians who received training as ED did have overall more concussion knowledge than physicians who were trained in other specialties (t(141)= -1.103, p=.03). Those who received training during residency evaluated more concussions than those who did not (t(150)= -.243, p=.016). Of physicians who received additional training, 85% routinely did not order imaging, while 69% of those without recent training did not order imaging (χ2 (2)= 7.34, p=.026). Almost 37% of physicians were not aware of RTP guidelines, 35% were aware and provided them to patients, while2% were not aware of RTP guidelines and yet provided them (χ2 (2)= -41.16, p=.000). CONCLUSIONS: Through assessing current education levels of physician’s awareness, gaps in knowledge and training exist. Results demonstrate the need for up-to-date concussion information for practicing ED physicians. In the current study, 63% of ED physicians were aware of RTP guidelines, which is higher than previous research has reported.

Abstract P2-12-12: Breast cancer in young women: Fertility preservation as a component of treatment planning and discussion

Abstract Background: as part of education and informed consent before cancer therapy, health care providers should address the possibility of infertility with patients (pts) treated during their reproductive years, and be prepared to discuss fertility preservation options and/or to refer all potential patients to Reproductive Specialists. I here we describe the recently established referral protocol of our institution with a fertility preservation centre. Both institutions belong to the Portuguese National Health System. Methods: the referral protocol includes female pts, ≤ 39 years old, with a diagnosis of breast or gynecological cancer or sarcoma with indication to curative intention chemotherapy. The possibility of fertility preservation is primarily discussed at the cancer centre and only interested pts are referred to the reproductive clinic, where specialized counseling is provided. Fertility preservation procedures (FPPs) (oocyte, embryo and/or ovarian tissue cryopreservation) are conditional to a previous evaluation of the ovarian pool (OP). OP markers are: antral follicle count, follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH). Only good prognosis cases are eligible for FPPs. Results: After primary discussion with eligible breast cancer (BC) pts, 17 were referred to the reproductive clinic: median age at BC diagnosis was 34 yrs (29-38), median previous pregnancies number of 0 (0-2) and median number of children of 0 (0-2). Marital status: most (64%) pts had a companion but 36% did not. All pts except 1 were candidates for immediate chemotherapy, either in the adjuvant or neoadjuvant setting. In the adjuvant setting (9 pts), median time from surgery until starting systemic treatment was 61.5 (43-146) days (aprox. 8,8 weeks); the case with a 146 day interval before chemotherapy was due to surgical complications and not to FPP. In the neoadjuvant setting (5 pts), median time between multidisciplinary decision and systemic treatment beginning was 17 (11-24) days (2,4 weeks). One patient was proposed to hormone therapy only after BC surgery and underwent FPP before systemic treatment. The timing for primary discussion of FPP was in multidisciplinary decision consultation. After counselling at the reproductive clinic, 2 pts declined FPP (%). For the other 13 pts oocyte cryopreservation was the FPP mostly used, although in one case embryo cryopreservation was performed. One case of ovarian hyperstimulation syndrome was observed but this FPP complication resolved without sequela and this event did not cause delay in chemotherapy treatment. Conclusions: our collaboration protocol allows for an efficacious referral of BC pts seeking fertility preservation counselling. Although BC patients may be focused initially on their cancer diagnosis, health care providers are encouraged to advise them regarding potential threats to fertility. Formal collaboration between cancer and reproductive centres, like the one described here, are crucial so as to allow for the widest array of options for fertility preservation and to prevent delay in cancer treatment. We intend to follow up these patients in order to realistically understand the impact of this practice in fertility and quality of life of cancer patients. Citation Format: Hugo Nunes, Fátima Vaz, Margarida Brito, Cláudia Melo, Ana Teresa Almeida Santos, António Moreira. Breast cancer in young women: Fertility preservation as a component of treatment planning and discussion [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-12-12.

Neuroimaging referral for dementia diagnosis: The specialist's perspective in Ireland

BackgroundNeuroimaging is an increasingly important tool in the diagnostic workup of dementia. Neurologists, geriatricians, and old-age psychiatrists are involved in key tasks in the diagnostic process, frequently referring patients with suspected dementia for neuroimaging. MethodsThe research design was a postal survey of all geriatricians, old-age psychiatrists, and neurologists in the Republic of Ireland (N = 176) as identified by the Irish Medical Directory 2011–2012 and supplementary listings. ResultsAlmost 65% of specialists did not have access to 2-[18F]fluoro-2-deoxy-D-glucose positron emission (FDG-PET) or FDG-PET/computed tomography (CT), and 80.3% did not have access to perfusion hexamethylpropyleneamine oxime single-photon emission computed tomography (SPECT) or dopaminergic iodine-123-radiolabeled 2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl) nortropane SPECT. Most specialists (88.7%) referred patients with mild cognitive impairment or suspected dementia for magnetic resonance imaging (MRI), 81.7% referred for CT, and 26.8% for FDG-PET or FDG-PET/CT. Only 44.6% of respondents were aware of dementia-specific protocols for referrals for neuroimaging. ConclusionSpecialist access to imaging modalities other than CT and MRI is restricted. Improved access may affect patient treatment and care.