Time intervals from the first symptom to surgery of ovarian malignancies in a tertiary government hospital

@#<p style="text-align: justify;"><strong>Objective.</strong> This is a cross-sectional study aimed to determine the time intervals from the first symptom to surgery of 37 patients with ovarian malignancies who underwent surgery at a tertiary government hospital from June to October 2019.</p><p style="text-align: justify;"><strong>Methods.</strong> Structured interviews of patients and chart reviews were conducted to identify the intervals and the reasons behind such. The data were analyzed using Stata/SE 14.1, with the time intervals presented as medians and the reasons as frequencies. Multinomial logistic regression analysis established the association of time intervals with the extent of surgery and final stage of ovarian malignancies.</p><p style="text-align: justify;"><strong>Results.</strong> The median Total Time Interval from the first symptom to surgery was 214 days. The longest delay was the Total System Interval (from the first visit at the tertiary hospital to surgery) with a median of 70 days. This was followed closely by Patient Interval (from the first symptom to consult with the initial physician) with a median of 64 days. A distant third was the Initial Physician Interval (from the consult with the initial physician to the first visit at the tertiary hospital) with a median of 29 days. Most common reasons for the delays were the patients not acknowledging the gravity of their condition for the Patient Interval; choice to go to other hospitals, distance and laboratory works or diagnostics for the Initial Physician Interval; waiting for laboratory work-ups for the First System Interval; and waiting for other departments' clearance for the Second System Interval. The most common first symptom was abdominal enlargement. The length of interval and the final stage (p=0.056 for Stage III and p=0.162 for Stage IV)) as well as extent of surgery (p=0.093) did not show significant association.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The time interval from first symptom to surgery showed a median of 214 days. The greatest delay is contributed by Total System Interval followed by Patient Interval due to varying reasons. Length of time intervals, however, was not found to be significantly associated with the extent of surgery and final stage</p>

Analysis of the delay of the first visit of new smear positive TB patients and the influencing factors in MaCheng of Hubei Province, 2016 -2018 / 公共卫生与预防医学

Objective: To explore the delay in the first diagnosis of tuberculosis patients in Macheng City from 2016 to 2018 and its influencing factors, so as to provide scientific basis for tuberculosis control. Methods A retrospective survey (face-to-face interview) was conducted on 372 new smear positive TB patients registered in the TB special report system of China's disease prevention and control information system from 2016 to 2018, Then the influencing factors of first visit delay were analyzed by single factor analysis and multi factor Logistic regression analysis. Results Among the 372 TB patients, 230 were delayed in the first diagnosis, the delay rate of the first diagnosis was 61.83%, the median delay time of the first diagnosis was 17.0d, and the average delay time was 37.74d.Multivariate logistic regression analysis showed that family financial difficulties (OR = 31.609, 95% CI: 7.240-138.010), no time (OR= 9.597, 95% CI: 2.014-45.729), not care (OR= 13.232, 95% CI: 2.978-58.804), Far away from the clinic (OR= 15.374, 95% CI: 2.896-81.616), non-agricultural occupational (OR = 31.4439, 95% CI: 4.398-224.8049), first visit in township (OR = 0.171, 95% CI: 0.037-0.785), the difference was statistically significant (P 0.05). Conclusion The first diagnosis delay rate of tuberculosis patients in Macheng City is high, some effective measures should be taken to minimize the first visit of TB patients.

Clinical Features of Relapsing Polychondritis Patients Presented with Arthropathy / 中国医学科学院学报

Objective To explore the clinical characteristics of relapsing polychondritis(RP)patients presented with arthropathy. Methods We retrospectively analyzed the clinical data of 201 RP patients who were hospitalized in our center between December 2005 and February 2019.After 16 patients with co-existing other autoimmune diseases and malignancies were ruled out,185 RP patients entered the final analysis,among whom 16 RP patients were presented with arthropathy and 169 without arthropathy.The demographic data,clinical manifestations,laboratory findings,and prognosis were compared between these two groups. Results Five of the 16 RP patients with arthropathy at presentation were misdiagnosed as rheumatoid arthritis.Compared with RP patients without arthropathy at presentation,RP patients with arthropathy at presentation had a longer disease course[(37.50±66.50)months

COVID-19 y el problema de los tiempos en las estrategias de control / COVID-19 and the problem of the times in the control strategies

Introducción: En el proceso de cuidados de paciente con sospecha de infección por el nuevo coronavirus (COVID-19) se incluyen elementos que deben ser considerados en las estrategias de prevención de la transmisión. Objetivo: Describir, a partir de la presentación de un caso confirmado con COVID-19, la cronología de los cuidados del paciente sospechoso o confirmado con la enfermedad y la necesidad de optimizar los tiempos de diagnóstico en la prevención de su transmisión. Presentación de caso: Paciente masculino de 59 años de edad con antecedentes de Hipertensión arterial y gota, y de profesión taxista. Siete días anteriores al ingreso comienza con los síntomas clínicos y se le realiza prueba rápida para COVID-19, la cual resultó negativa. Al quinto día de ingreso de aislamiento en habitación privada se le realiza PCR y se confirma la infección por coronavirus. Se traslada a institución dedicada a la atención de estos pacientes donde presenta recuperación sin complicaciones. Se describen los intervalos de tiempo en relación con los cuidados en especial énfasis a la demora diagnóstica. Conclusiones: Se requiere un monitoreo de la dinámica de los cuidados de los pacientes sospechosos de COVID-19 con un especial enfoque en el fortalecimiento de la prevención de la transmisión nosocomial y en la comunidad(AU)

Introduction: In the process of caring for patients with suspected coronavirus infection (COVID-19), elements that must be considered in transmission prevention strategies are included. Objective: To describe, based on the presentation of a case confirmed with COVID-19, the chronology of patients suspected or confirmed with the disease and the need to optimize diagnosis times in the transmission prevention. Case presentation: Fifty-nine-year-old male patient with a history of high blood pressure and gout, working as a taxi driver. Seven days before admission, he began with symptoms. A rapid test for COVID-19 was performed, which was negative. On the fifth day of isolation in a private room, PCR was performed and coronavirus infection was confirmed. He was moved to an institution dedicated to the care of these patients where he recovered without complications. Time intervals concerning care are described with special emphasis on diagnostic delay. Conclusion: Monitoring of the care dynamics of patients suspected of COVID-19 is required with a special focus on strengthening the prevention of nosocomial transmission and the prevention of the spreading of the disease in the community(AU)

Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil / Atrasos no sistema de saúde para crianças, adolescentes e adultos jovens com tumores ósseos no Brasil

ABSTRACT Objective: To identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0-29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries. Methods: Patient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days. Results: There was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay. Conclusion: Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

RESUMO Objetivo: Identificar atrasos no sistema de saúde em crianças e adolescentes e adultos jovens (AAJ; até 29 anos) com osteossarcoma e sarcoma de Ewing com informações dos registros de câncer de base hospitalar do Brasil. Métodos: Os dados dos pacientes foram extraídos de 161 registros de câncer de base hospitalar brasileiros entre 2007 e 2011. Os atrasos no hospital, no diagnóstico e no tratamento foram analisados em pacientes sem um diagnóstico histopatológico anterior. Os atrasos no encaminhamento, no hospital e no sistema de saúde foram calculados para pacientes com diagnóstico histopatológico anterior. O intervalo de tempo foi medido em dias. Resultados: Não houve diferença entre os sexos nos atrasos em geral. Todos os atrasos aumentaram na faixa etária mais velha. Os pacientes sem um diagnóstico histopatológico anterior apresentaram o atraso hospitalar mais longo em comparação com os pacientes com diagnóstico histopatológico anterior antes do primeiro contato com o centro de câncer. Os pacientes com sarcoma de Ewing apresentaram atrasos no encaminhamento e no sistema de saúde mais longos do que os com osteossarcoma, que apresentaram diagnóstico histopatológico anterior antes do primeiro contato com o centro oncológico. As regiões Norte e Nordeste apresentaram o atraso mais longo no diagnóstico, ao passo que as regiões Nordeste e Sul apresentaram o atraso mais longo no tratamento. Conclusão: O atraso no sistema de saúde entre os pacientes com diagnóstico anterior foi maior e provavelmente associado ao tempo de encaminhamento para os centros oncológicos. Os pacientes sem um diagnóstico histopatológico anterior apresentaram atrasos mais longos no hospital, o que pode ser associado a possíveis dificuldades com relação à demanda e aos procedimentos de alto custo. Apesar das limitações, nosso estudo ajuda a fornecer um conhecimento inicial sobre os atrasos no sistema de saúde para tratamento de pacientes com câncer em vários hospitais brasileiros.

An analysis on the delay factors of the treatment and diagnosis among pulmonary tuberculosis patients / 预防医学

Objective To understand the delay factors of the treatment and diagnosis among pulmonary tuberculosis patients, and to provide scientific evidence for tuberculosis control.Methods A total of 128 pulmonary tuberculosis patients who was newly diagnosed and treated in Xiaoshan were enrolled in this study.The data of demography,medical history and tuberculosis knowledge were collected through questionnaires.Statistical method was used to analyze the current situation and delay factors of the treatment and diagnosis.Results The rate of treatment delay was 25.00%.Female patients without hemoptysis symptom,maintenance elderly,little knowledge of tuberculosis and low degree of education were relative to treatment delay among pulmonary tuberculosis patients (P <0.05 ).Multivariate logistic regression analysis showed that female(OR =6.39,95%CI:1.66 -24.61),was the delay factors of treatment.The rate of diagnosis delay was 50.78%.Multivariate logistic regression analysis showed that preliminary treatment in village or private clinics (OR =2.10,95%CI:1.00 -4.39),preliminary treatment without X ray (OR =3.91,95%CI:1.16 -13.19)and maintenance elderly (OR =57.43,95%CI:4.43 -744.30)were risk factors for delayed diagnosis.Conclusion The influencing factor for treatment and diagnosis delay are female,preliminary treatment in village or private clinics,preliminary treatment without X ray and maintenance elderly.